Midline Skull Base Meningiomas: Transcranial and Endonasal Perspectives

Abstract

Skull base meningiomas have always represented a challenge for neurosurgeons. Despite their histological nature, they may be associated with unfavorable outcomes due to their deep-seated location and the surrounding neurovascular structures. The state of the art of skull base meningiomas accounts for both transcranial, or high, and endonasal, or low, routes. A comprehensive review of the pertinent literature was performed to address the surgical strategies and outcomes of skull base meningioma patients treated through a transcranial approach, an endoscopic endonasal approach (EEA), or both. Three databases (PubMed, Ovid Medline, and Ovid Embase) have been searched. The review of the literature provided 328 papers reporting the surgical, oncological, and clinical results of different approaches for the treatment of skull base meningiomas. The most suitable surgical corridors for olfactory groove, tuberculum sellae, clival and petroclival and cavernous sinus meningiomas have been analyzed. The EEA was proven to be associated with a lower extent of resection rates and better clinical outcomes compared with transcranial corridors, offering the possibility of achieving the so-called maximal safe resection.

Pterional Approach for A Tuberculum Sellae Meningioma: A Case Report

“…An additional monolateral orbitotomy can be added to obtain a wide inferosuperior trajectory. As reported by Chokyu, the optic canals may be unroofed, depending on the degree of tumor invasion, thus increasing the visual improvement [12].…”

“…Also, among other techniques includes minimally invasive Key Hole surgeries such as mini-supraorbital craniotomy, and the extended transplanum-transtubercular endoscopic endonasal approach, which show notable results in these patients, increasing their efficacy and reducing their morbidity and mortality, [1,2,6,5,9,11]. Taking into account the two pillars of meningioma surgery: maximizing the extent of resection (EOR) and reducing the risk of recurrence while preserving neurological functions [12]. Highlighting the importance of evaluating pre and post-surgical visual perimetry to determine visual recovery [1].…”

“…The anterior interhemispheric approach (AHA) is defended by authors such as Curey et al (2012), this being an approach whose advantage is allowing symmetrical vision and control of the optical apparatus, ICAs and their terminal, and distal collateral branches without extensive retraction. Furthermore, its trajectory is directly along the dorsum and diaphragm sellae, thus allowing for the direct oversight of tumor posteroinferior extension [12,13].…”

“…Likewise, through the contralateral Subfrontal route, manipulation of the optic nerve is reduced and the inferomedial aspect of the compromised optic nerve is visualized, which could result in improved postoperative visual results (Jangy col. 2012) [6,7,8]. Likewise, the unilateral subfrontal pathway, via both supraorbital and frontal approaches, attains a broader view over the planum sphenoidale and tuberculum sellae than a transsylvian corridor [12].…”

A radiomics-based study for differentiating parasellar cavernous hemangiomas from meningiomas

“…However, SRS increases the risk of adhesion between meningiomas and surrounding tissues, which is not the preferred method for meningiomas. Surgical resection is considered to be an effective strategy for the treatment of parasellar meningiomas 15 , and SRS is an adjuvant treatment for residual or recurrent meningiomas after surgery 5,16,17 . Consequently, accurate preoperative diagnosis for parasellar CHs and meningiomas is crucial for individualized treatment decisions.…”