Endoscopic Endonasal Surgery for Suprasellar Meningiomas: Experience with 75 Cases

Objective: Endoscopic endonasal surgery (EES) has been recently introduced in the treatment of skull base meningiomas. Study Design: Retrospective review. Methods: Retrospective chart review of 75 patients with suprasellar meningiomas who underwent EES. Results: Most patients presented with visual loss (81.3%). Tumors extended into the optic canal(s) in 26.7%. Complete tumor resection (Simpson grade I) was achieved in 81.4% of the 70 patients in whom it was the goal (76% overall). In cases with optic canal invasion, complete resection was 90%. Tumor size, configuration, and vascular encasement were significant factors affecting the degree of resection (p < 0.0001). Vision was improved/normalized in 85.7% of the cases. Postoperative visual deterioration occurred in two patients (3.6%). Complications included CSF leak (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 multisystem organ failure. No patient developed postoperative cerebral contusions, hemorrhage, or seizures. During a mean follow-up period of 29 months (range, 1-98 months), one patient underwent repeat EES for progression of residual tumor. Conclusions: EES is an effective and safe approach for the treatment of suprasellar meningiomas with excellent visual outcomes regardless of tumor location and extension into the optic canals.