Endoscopic Endonasal Resection of Anterior Skull Base Meningiomas

Padhye, Vikram MBBS
Naidoo, Yuresh MBBS, FRACS
Alexander, Hamish MBChB
Floreani, Stephen MBBS, FRACS
Robinson, Simon MBChB, FRACS
Santoreneos, Stephen MBBS, FRACS
Wickremesekera, Agadha MBChB, FRACS, MD
Brophy, Brian MBBS, FRACS
Harding, Marguerite MBChB, MMed, FRACS
Vrodos, Nick MBBS, FRACS
Wormald, Peter-John MBChB, FCS, FRCS, FRACS

¹Department of Otolaryngology, The Queen Elizabeth Hospital, South Australia, Australia ²Wellington Hospital, Wellington, New Zealand ³The Royal Adelaide Hospital, South Australia, Australia ⁴Flinders Medical Centre, South Australia, Australia

Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Received October 31, 2011; revised March 13, 2012; accepted April 5, 2012.

This article was presented at the 2011 AAO-HNSF Annual Meeting & OTO EXPO; September 11–14, 2011; San Francisco, California.

Corresponding Author: Vikram Padhye, MBBS, Department of Otolaryngology, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville South, South Australia, Australia 5011

Email: [email protected]

Otolaryngology - Head & Neck Surgery 147(3):p 575-582, September 2012. | DOI: 10.1177/0194599812446565

Abstract

Objective.

Anterior cranial fossa (ACF) meningiomas are difficult to surgically manage. Endoscopic transnasal approaches have increasingly been used as a minimally invasive route and thus offer significant advantages. However, a paucity of literature describing the intraoperative challenges and postoperative outcomes of this technique still exists.

Study Design.

Case series with chart review.

Setting.

The Royal Adelaide Hospital, Flinders Medical Centre, Wellington Hospital.

Subjects and Methods.

Fifteen consecutive patients who underwent endoscopic resection of ACF meningiomas between 2004 and 2010 by the South Australian and Wellington Skull Base Units. Demographic and clinical information was compiled by reviewing patient charts and operation notes. Safety and efficacy of the procedure, role of a team approach, and areas for further improvement were analyzed.

Results.

Of the patients, 87% were women. Tumor locations: 8 olfactory groove, 2 tuberculum sellae, 1 clinoidal, 1 jugum sphenoidale, 1 planum sphenoidale, 1 subfrontal, and 1 midline ACF floor. Commonest presenting symptom was visual change. Mean volume of tumor was 25.69 cm³, with a size area of 7.28 cm². Five were revision cases. None had previous endonasal surgery. Average operating times decreased over time. Gross total removal was achieved in 14, with no deaths. Four patients had postoperative cerebrospinal fluid (CSF) leak. Rate of CSF leak decreased over time. Sixty percent of patients reported visual improvement. Two patients had radiological evidence of recurrence.

Conclusion.

ACF meningiomas can be safely removed endonasally, offering significant advantages over the traditional transcranial approach for suitable tumors. Early audit of this approach shows results achieved by this unit are comparable with the published literature.