Giant Meningiomas of the Anterior and Middle Fossa: Removal under Endoscope-Assisted Key “Burr” Hole Conditions via an Eyebrow Incision

Introduction: Conventional open surgery of giant meningiomas contains some special difficulties. In the present study, we retrospectively analyzed the surgical technique, and outcome in 40 patients with giant meningiomas located in the frontal fossa and partly extended into the middle fossa. All patients were treated via a keyhole craniotomy as large as necessary to host the instruments and as small as possible to achieve the best surgical result. Methods: Within 5 years, 40 patients underwent surgery in the frontal and temporal base for giant meningiomas (diameter > 5 cm). Pathologies were located bilateral in the olfactory groove, tuberculum sellae, medial sphenoid wing, planum sphenoidale, and anterior side of the falx cerebri. The eyebrow skin incision was between 2.5 and 3 cm long and was made without shaving the patient's eyebrow hair. Subsequently, a key “burr” hole craniotomy was performed of approximately 0.8 ×1.2 to 1.4 cm in diameter. Results: Headache and psychoorganic syndrome were the most common presenting symptoms in all patients. Disturbances were associated in detail with psychological deterioration in 23 cases, visual disorder in 19 patients, and anosmia in 17 patients. Intraoperative complications were not existed. Postoperative two patients underwent emergency surgery because of an acute subdural bleeding and a pneumocephalus. Conclusion: Choosing the correct placed keyhole approach with a refinement of the classic keyhole craniotomy to a more smaller key “burr” hole approach, with the use of modern and new designed endoscopic equipment it is possible to perform complex skull base procedures with the same safety, efficiency, and less complication rates.