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.
