Endoscopic Transglabellar Approach for Midline Frontal Tumor: About a Series of 30 Patients

A total of 30 consecutive patients underwent endoscopic transglabellar resection of anterior cranial fossa meningioma between 2010 and 2013. We have modified the transfrontal approach by progressively limiting the extent of the osteotomies that we use for access. After a skin incision of 2 cm in front of the glabella, the anterior wall of the frontal sinus is then osteotomized. Mucosa is drilled. The frontonasal duct is closed and the sinus is cranialized. The posterior table of the frontal sinus is then removed with a round cutting burr. The debulking of the tumor is done under endoscopic view. After the resection of the tumor, the dura mater is closed. The anterior wall of the frontal sinus is replaced and secured with miniplates to the surrounding frontal bone. Of the patients, 70% were women. Tumor locations: 10 giant olfactory grooves, 10 olfactory grooves, 5 tuberculum sellae, and 5 jugum sphenoidale. Common presenting symptom was frontal syndrome (50%), visual change (30%), and anosmia (30%). Gross-total removal was achieved for all patients (Simpsons 2), with no deaths. Three patients had postoperative cerebrospinal fluid (CSF) leak. Around 60% of patients reported visual improvement. At the end of follow-up (22 months) we did not find any evidence of clinical or radiological recurrence. The cosmetic result is excellent for 20 patients and very good for 10 patients. ACF meningioma can be safely removed by an endoscopic transglabellar approach with an excellent cosmetic result, offering significant advantages over the traditional transcranial approach for suitable tumors.