Endoscopic Endonasal Surgery for Suprasellar Meningiomas

Objective: Endoscopic endonasal surgery (EES) has been recently introduced in the treatment of skull base meningiomas. We retrospectively review the effectiveness of EES in the management of suprasellar meningiomas.

Methods: Between 2002 and 2011, 75 patients (81.3% female) with suprasellar meningiomas underwent EES at the University of Pittsburgh Medical Center. We present the results of EES and analyze the resection rates, visual outcomes, and complications.

Results: Most patients presented with visual loss (81.3%). Tumors involved the tuberculum sellae (85.3%) and planum sphenoidale (50.7%), with extension into the optic canal(s) in 26.7% (unilateral in 22.7% and bilateral in 4%). Complete tumor resection (Simpson grade I) was achieved in 79.2% of the cases. Among the cases with optic canal invasion, complete resection was 90%. Tumor size, configuration, and vascular encasement were significant factors that influenced the degree of resection (P < 0.0000). Vision was improved or normalized in 85.7% of the cases. Postoperative visual deterioration occurred in two patients (3.6%). Complications included cerebrospinal fluid leakage (16.1% in recent years) resulting in meningitis in four cases. One patient had an intraoperative vascular injury resulting in neurological deficits. Another elderly patient died within a month after EES from multiple unexplained cerebral infracts and multisystem organ failure. No patient developed postoperative cerebral contusions, hemorrhage, or seizures. During a mean follow-up period of 24.6 months (range, 1-98 months), one patient underwent repeat EES for progression of residual tumor.

Conclusions: With the goal of gross total tumor resection and visual improvement, EES is an effective and safe approach for the treatment of suprasellar meningiomas.