Endoscopic endonasal surgery for suprasellar meningiomas: experience with 75 patients

Koutourousiou, Maria; Fernández-Miranda, Juan C.; Stefko, S. Tonya; Wang, Eric; Snyderman, Carl H.; Gardner, Paul A.

doi:10.3171/2014.2.jns13767

Cited by 158 publications

(184 citation statements)

References 55 publications

Supporting

Mentioning

172

Contrasting

Unclassified

Order By: Relevance

“…The main disadvantage of EES is the increased risk of CSF leakage, which necessitates repeat surgeries for repair and a potentially higher risk of postoperative meningitis and abscess. Although the evolution of the vascularized reconstruction technique with the nasoseptal flap has dramatically decreased the CSF leak rates in suprasellar meningioma surgery, 19,25,26,43 there are still concerns about the ideal * Differing complication rates in different age groups, tumor size, and number of surgeries were not significant. † Abscesses formed several months or years after surgery.…”

Section: Anterior (Subfrontal and Supraorbital) Approachmentioning

confidence: 99%

“…And, although the innovation of the vascularized nasoseptal reconstruction technique has dramatically decreased the CSF leak rates in other pathological entities, the extensive skull base defect after olfactory groove meningioma surgery remains a reconstruction challenge. 19,[25][26][27][28]43 Our technique has changed since this series to include a 3-layer technique as described by Eloy et al 14 In addition, the more recent use of the wider and longer extracranial pericranial flap has shown no failure so far (our unpublished data, 2014), and it may represent the ideal available technique to avoid CSF leakage following EES for olfactory groove meningioma. Further advances and innovative materials for skull base reconstruction are needed and expected to minimize this complication.…”

Section: Surgical Complicationsmentioning

confidence: 99%

“…The surgical technique of EES for anterior skull base tumors has already been described in detail. 7,12,13,17,18,24,26,37 As a result of this direct approach to the tumor from below, EES provides wide visualization of the whole skull base, complete resection of all abnormal bone and mucosa underlying the tumor, early devascularization of the meningioma, and direct visualization of the neurovascular structures of the suprasellar and infrachiasmatic region from below, allowing for a safe tumor resection with minimal neurovascular manipulations (Figs. 5 and 6).…”

Section: Anterior (Subfrontal and Supraorbital) Approachmentioning

confidence: 99%

“…Specifically for the visual outcome, we believe that the excellent visualization and attendant preservation of microvasculature of the optic nerves and/or chiasm provided by the endoscope, as well as the wide optic nerve decompression in cases of optic canal invasion by the tumor and/or papilledema, explain the superior outcomes compared with open surgeries, a fact that has already been demonstrated in suprasellar meningioma surgery. 26 Olfaction is not addressed directly in our outcomes because loss is expected. Two patients underwent a unilateral approach in an attempt to preserve olfaction.…”

mentioning

confidence: 99%

“…7,8,12,13,[16][17][18]24,26,37 Endoscopic endonasal surgery provides panoramic visualization and wide access to the anterior skull base from below, allowing for total resection of the involved/diseased bone and mucosa and early devascularization of the tumor with no frontal lobe manipulation. Large tumors with encasement of the surrounding arteries remain challenging to treat regardless of the approach, but EES presents its own advantages and limitations.…”

mentioning

confidence: 99%

See 4 more Smart Citations

Endoscopic endonasal surgery for olfactory groove meningiomas: outcomes and limitations in 50 patients

Koutourousiou

Fernández-Miranda

Wang

et al. 2014

FOC

Self Cite

112

View full text Add to dashboard Cite

Object Recently, endoscopic endonasal surgery (EES) has been introduced in the management of skull base tumors, with constantly improving outcomes and increasing indications. The authors retrospectively reviewed the effectiveness of EES in the management of olfactory groove meningiomas. Methods Between February 2003 and December 2012, 50 patients (64% female) with olfactory groove meningiomas underwent EES at the University of Pittsburgh Medical Center. The authors present the results of EES and analyze the resection rates, clinical outcome, complications, and limitations of this approach. Results Forty-four patients presented with primary tumors, whereas six were previously treated elsewhere. The patients’ mean age was 57.1 years (range 27–88 years). Clinical presentation included altered mental status (36%), visual loss (30%), headache (24%), and seizures (20%). The mean maximum tumor diameter was 41.6 mm (range 18–80 mm). All patients underwent EES, which was performed in stages in 18 giant tumors. Complete tumor resection (Simpson Grade I) was achieved in 66.7% of the 45 patients in whom it was the goal, and 13 (28.9%) had near-total resection (> 95% of the tumor). Tumor size, calcification, and absence of cortical cuff from vasculature were significant factors that influenced the degree of resection (p = 0.002, p = 0.024, and p = 0.028, respectively). Tumor residual was usually at the most lateral and anterior tumor margins. Following EES, mental status was improved or normalized in 77.8% of the cases, vision was improved or restored in 86.7 %, and headaches resolved in 83.3 %. There was no postoperative deterioration of presenting symptoms. Complications were increased in tumors > 40 mm and included CSF leakage (30%), which was significantly associated with lobular tumor configuration (p = 0.048); pulmonary embolism/deep vein thrombosis, more commonly in elderly patients (20%); sinus infections (10%); and delayed abscess months or years after EES (6%). One patient had an intraoperative vascular injury resulting in transient hemiparesis (2%). There were no perioperative deaths. During a mean follow-up period of 32 months (median 22 months, range 1–115 months), 1 patient underwent repeat EES for tumor regrowth. Conclusions Endoscopic endonasal surgery has shown good clinical outcomes regardless of patient age, previous treatment, or tumor characteristics. Tumor size > 40 mm, calcification, and absence of cortical vascular cuff limit GTR with EES; in addition, large tumors are associated with increased postoperative complications. Significant lateral and anterior dural involvement may represent indications for using traditional craniotomies for the management of these tumors. Postoperative CSF leakage remains a problem that necessitates innovations in EES reconstruction techniques.

show abstract

Section: Anterior (Subfrontal and Supraorbital) Approachmentioning

confidence: 99%

Section: Surgical Complicationsmentioning

confidence: 99%

Section: Anterior (Subfrontal and Supraorbital) Approachmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 3 more Smart Citations

Endoscopic endonasal surgery for olfactory groove meningiomas: outcomes and limitations in 50 patients

Koutourousiou

Fernández-Miranda

Wang

et al. 2014

FOC

Self Cite

112

View full text Add to dashboard Cite

show abstract

Accuracy of computer‐assisted navigation: significant augmentation by facial recognition software

Glicksman

Reger

Parasher

et al. 2017

Int Forum Allergy Rhinol

View full text Add to dashboard Cite

show abstract

ICAR: endoscopic skull‐base surgery

Wang

Zanation

Gardner

et al. 2019

Int Forum Allergy Rhinol

Self Cite

160

279

View full text Add to dashboard Cite

Background Endoscopic skull‐base surgery (ESBS) is employed in the management of diverse skull‐base pathologies. Paralleling the increased utilization of ESBS, the literature in this field has expanded rapidly. However, the rarity of these diseases, the inherent challenges of surgical studies, and the continued learning curve in ESBS have resulted in significant variability in the quality of the literature. To consolidate and critically appraise the available literature, experts in skull‐base surgery have produced the International Consensus Statement on Endoscopic Skull‐Base Surgery (ICAR:ESBS). Methods Using previously described methodology, topics spanning the breadth of ESBS were identified and assigned a literature review, evidence‐based review or evidence‐based review with recommendations format. Subsequently, each topic was written and then reviewed by skull‐base surgeons in both neurosurgery and otolaryngology. Following this iterative review process, the ICAR:ESBS document was synthesized and reviewed by all authors for consensus. Results The ICAR:ESBS document addresses the role of ESBS in primary cerebrospinal fluid (CSF) rhinorrhea, intradural tumors, benign skull‐base and orbital pathology, sinonasal malignancies, and clival lesions. Additionally, specific challenges in ESBS including endoscopic reconstruction and complication management were evaluated. Conclusion A critical review of the literature in ESBS demonstrates at least the equivalency of ESBS with alternative approaches in pathologies such as CSF rhinorrhea and pituitary adenoma as well as improved reconstructive techniques in reducing CSF leaks. Evidence‐based recommendations are limited in other pathologies and these significant knowledge gaps call upon the skull‐base community to embrace these opportunities and collaboratively address these shortcomings.

show abstract

Endoscopic endonasal surgery for suprasellar meningiomas: experience with 75 patients

Cited by 158 publications

References 55 publications

Endoscopic endonasal surgery for olfactory groove meningiomas: outcomes and limitations in 50 patients

Endoscopic endonasal surgery for olfactory groove meningiomas: outcomes and limitations in 50 patients

Accuracy of computer‐assisted navigation: significant augmentation by facial recognition software

ICAR: endoscopic skull‐base surgery

Contact Info

Product

Resources

About