Endoscopic endonasal versus open transcranial resection of anterior midline skull base meningiomas

Ricardo J. Komotar, Robert M. Starke, Daniel M.S. Raper, Vijay K. Anand, Theodore H. Schwartz

Research output: Contribution to journalReview articlepeer-review

127 Scopus citations

Abstract

Objective: To assess the advantages and limitations of the endoscopic endonasal approach to anterior skull base meningiomas, a minimally invasive approach that avoids extensive bone drilling, brain retraction, and manipulation of nerves and critical vessels, versus open transcranial surgery. Methods: A MEDLINE (2000-2010) search was performed to identify series for either olfactory groove meningiomas or tuberculum sellae (TS) or planum sphenoidale meningiomas. Statistical analyses of categorical variables such as extent of resection, morbidity, and visual outcome were performed using χ 2 and Fisher exact tests. Results: The literature review included 60 studies, involving 1426 patients. Open surgery achieved a higher rate of gross total resection (GTR) for both olfactory groove (P < 0.001) and TS and planum (P < 0.001) meningiomas. Postoperative cerebrospinal fluid (CSF) leak occurred more frequently in the endoscopic cohort (P < 0.001). Other postoperative complications occurred more frequently in the open cohort, although this difference was not statistically significant. There were no significant differences in postoperative visual outcome between the groups. Conclusions: Based on the current literature, open transcranial approaches for olfactory groove and TS and planum sphenoidale meningiomas still result in higher rates of total resection with lower postoperative CSF leak rates. The endoscopic endonasal approach may be safe and effective for certain skull base meningiomas; careful patient selection and multilayer closure techniques are essential.

Original languageEnglish (US)
Pages (from-to)713-724
Number of pages12
JournalWorld neurosurgery
Volume77
Issue number5-6
DOIs
StatePublished - May 1 2012
Externally publishedYes

Keywords

  • Endonasal
  • Endoscopic
  • Meningioma
  • Minimal access
  • Minimally invasive
  • Olfactory groove
  • Outcomes
  • Planum sphenoidale
  • Skull base
  • Surgery
  • Systematic review
  • Tuberculum sellae

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

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