Surgical Nuances of Microsurgical Keyhole and Endonasal Endoscopic Approaches for Management of Intracranial Meningiomas

With advancements in microsurgical technology and instrumentation, keyhole craniotomies and endoscopic endonasal approaches are being increasingly explored for lesions of the skull base. We evaluate the technical aspects and surgical nuances of these approaches for management 25 patients with a total of 31 intracranial meningiomas.

Results: Of the 31 tumors in this study, 28 were treated with a total of 31 intracranial procedures. Keyhole approaches included supraorbital “eyebrow” craniotomy for 7 patients, “mini-pterional” for 2, keyhole retrosigmoid for 4, endonasal endoscopy for 1 and combined keyhole/ endoscopy for 5 patients. We also utilized tailored keyhole approaches for 6 patients with various supratentorial lesions such as falx or convexity meningiomas. 28% of the patients were male and 72% female. The mean age for the patient cohort was 56 years. All but two patients had WHO grade I tumors. The mean operative time was 7 hours, 11 minutes. Simpson Resection grades were as follows: Grade I = 7, II = 6, III = 1, IV = 14, V = 0. The mean post-operative hospital stay was 5.3 days. Eleven patients received adjuvant radiation. Preoperative neurologic deficits were seen in 15 patients, including visual loss in 9; all but four patients had improvement or resolution at time of last followup. Two patients experienced new-onset cranial nerve palsies, both of which which were improved at time of last followup.

Conclusion: Our resuts show satisfactory patient outcomes with minimal complications, morbidity and no mortality utilizing tailored keyhole approaches for resection of various intracranial meningiomas. With careful preoperative evaluation of the imaging and tumor characteristics, single approaches or a combination of specifically tailored corridors can be utilized to manage a range of lesions from straightforward to quite challenging locations with reasonable results.