Supraorbital Keyhole Approach for Anterior Cranial Fossa Meningiomas

Background: Keyhole craniotomies are increasingly being used for lesions of the skull base. Here, we present our experience with keyhole approaches for resection of anterior cranial fossa meningiomas.

Purpose: To evaluate possibilities of transciliary supraorbital approach for anterior cranial fossa meningiomas.

Material and Methods: During the period 2010–2016, a total of 48 patients were operated on at our neurosurgical clinic (13 men, 35 women, 35–68 years old, mean age: 47 years) with meningiomas of the anterior cranial fossa (15 olfactory meningiomas, 24 planum sphenoidale meningiomas, 9 meningiomas of the tuberculum sellae). The tumor diameter varied from 15 to 40 mm. The tumor diameter is divided into small (<2.5 cm), medium (2.5–4.5 cm) and large (> 4.5 cm). Tumors were removed by transciliary approach both microsurgically and with endoscopic assistance.

Results: Gross-total resection was achieved in 46 (95.8%) patients, subtotal in 2 (4.2%). Out of 13 patients with visual impairment, 9 patients improved, one remained stable, and three deteriorated. Three patients had tumor recurrence, CSF leak in one, 2 patients had palsy of frontal branch of the facial nerve. Cosmetic result in all patients was satisfactory.

Conclusion: Transciliary supraorbital approach is a modern minimally invasive modification of subfrontal approach, which allows to remove anterior cranial fossa meningiomas up to a large size radically and with good functional results. Endoscopic assisting gives an additional visualization with more radical tumor removal and more effective hemostasis. In surgical tactics, an essential condition for the effectiveness of the operation is the decompression of not only the trigeminal nerve, but also the decompression of the brainstem to eliminate pulsatile effects on the trigeminal nerve.