Endoscopic Transnasal Resection of Midline Skull Base Meningioma: Tumor Consistency and Surgical Outcome

Background Endoscopic transnasal approach (ETA) has proven to be of a great value in the resection of midline skull base meningiomas compared with traditional approaches. Our objective is to assess tumors consistency in relation to the surgical outcomes for midline meningioma (MM) resected utilizing the ETA.

Methods A sample of 12 patients were assessed retrospectively. Radiological preoperative features including tumor to cerebellar peduncle T2-weighted MRI ratio (TCTI) was evaluated. The intraoperative consistency assessment was done by the operating surgeon and was determined to be soft (respectable by suction/manual manipulation) or firm (needed cavitation ultrasonic aspirator). Surgical resection, intraoperative complications, and postoperative complications were evaluated in relation to tumor consistency.

Results Of the 12 patients evaluated, 6 were classified to be firm and 6 were soft. The TCTI ratio was calculated for 91% of the cohort (mean ratio of 1.6). All firm tumors had a ratio of ≤1.6 with one outlier of 1.7. On the contrary, soft tumors had a ratio of ≥1.6 with one outlier of 1.3; 66.67% of patients with solid tumors had complications compared with 16.67% in patients with soft tumors. Complications included intraoperative major vessel injury, postoperative cerebrospinal fluid leak, and brain abscess. Only 33% of solid tumors had gross total resection (GTR) in comparison to 67% GTR in tumors with soft consistency.

Conclusion In our retrospective analysis, we found that tumor consistency is significantly related to short-term surgical outcomes in MM resected utilizing the ETA. We suggest that traditional cranial approaches should be considered as the first surgical option in solid MM. Prospective evaluation is needed to further evaluate our findings.