Transglabellar Endoscopic Approach for Anterior Skull Base Surgery

Sixty consecutive patients underwent endoscopic transglabellar resection of anterior skull base meningioma between 2010 and 2016 by our center. We use an inter-eyebrow, symmetrical skin incision. 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 are 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. The anterior wall of the frontal sinus is then replaced and secured with miniplates to the surrounding frontal bone.

Results: Tumor locations: 18 giants olfactory groove, 16 olfactory groove, 14 tuberculum sellae, 12 jugum. Gross total removal was achieved for all patients (Simpsons 2), with no deaths. 6 patients had postoperative cerebrospinal fluid (CSF) leak. Rate of CSF leak decreased over time with a better procedure of frontonasal duct closing. At the end of follow up (50 months) we didn't find evidence of clinical or radiological recurrence. The cosmetic result is excellent for 50 patients and very good for 10 patients.