Indications and Limitations of the Endoscopic Endonasal Approach for Anterior Skull Base Meningiomas: A Comparison with Conventional Microscopic Transcranial Resection

Background: Transcranial resection (TCR) had been the traditional approach for anterior skull base meningiomas originating from the planum sphenoidale (PS) and the tuberculum sellae (TS). We had been developing a treatment strategy based on TCR for anterior skull base meningiomas and have recently introduced an endoscopic endonasal approach (EEA). This study aimed to evaluate the outcomes of EEA for PS/TS meningiomas in comparison with TCR.

Methods: In this single-center retrospective study, factors affecting progression-free survival rates (PFRs), neurological outcomes, endocrine function preservation and disease-specific survival (DSS) in 45 patients undergoing TCR or EEA for PS/TS meningiomas were evaluated.

Results: The mean observation period was 75 months, the mean maximum tumor diameter was 23 mm, and the mean tumor volume was 6.1 cm3. Twenty-four (53%) patients were treated with TCR and 21 (47%) patients with EEA. Simpson grade I-III resection was achieved in 31 patients (69%) without any significant differences (TCR 71% vs. EEA 62%; p = 0.526). The cumulative 3-, 5-, and 10-year PFRs following surgery were 88%, 84%, and 80%, respectively. No significant differences in the PFRs were observed between TCR and EEA groups (TCR; 95%/3 y, 83%/5–10 y versus EEA; 75%/3 y, 75%/5 y, log-rank test; p = 0.248). Postoperative visual improvement was significantly better in the EEA group (TCR 38% vs. EEA 100%; p = 0.001) and the rates of perioperative adverse events were significantly lower in the EEA group (TCR 58% vs. EEA 9%; p = 0.001). Endocrine function preservation was achieved in all patients with EEA (TCR 88% vs. EEA 100%; p = 0.094). There were no postoperative CSF leaks. The cumulative 10-year DSS was 100%.

Conclusion: EEA for PS/TS meningiomas may be a useful treatment option, achieving favorable tumor control and excellent visual improvement without increasing the risk of adverse events.

Publication History

Article published online:
01 February 2023