J Neurol Surg B Skull Base 2023; 84(S 01): S1-S344
DOI: 10.1055/s-0043-1762034
Presentation Abstracts
Oral Abstracts

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

Yuki Shinya
1   The University of Tokyo Hospital, Tokyo, Japan
,
Hirotaka Hasegawa
1   The University of Tokyo Hospital, Tokyo, Japan
,
Kei Arisawa
1   The University of Tokyo Hospital, Tokyo, Japan
,
Masahiro Shin
2   University of Teikyo Hospital, Tokyo, Japan
,
Motoyuki Umekawa
1   The University of Tokyo Hospital, Tokyo, Japan
,
Nobuhito Saito
1   The University of Tokyo Hospital, Tokyo, Japan
› Author Affiliations
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    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.


     

    No conflict of interest has been declared by the author(s).

    Publication History

    Article published online:
    01 February 2023

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