The Impact of Age on Long-Term Quality of Life After Endonasal Endoscopic Resection of Skull Base Meningiomas

Jones, Samuel H.; Iannone, Andrew F.; Patel, Kunal; Anchouche, Khalil; Raza, Shaan M.; Anand, Vijay K.; Schwartz, Theodore H.

doi:10.1227/neu.0000000000001360

Cited by 35 publications

(19 citation statements)

References 53 publications

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“…Consistent with our analysis, age >60 years has been associated with systemic complications in these patients . Age >55 years has also been shown to be associated with reduced postoperative quality of life as compared with their counterparts . With regard to other predictive factors, a study looking at all transsphenoidal surgery types also determined higher ASA class to be associated with adverse events with VSB.…”

Section: Discussionsupporting

confidence: 86%

Morbidity and mortality associated with ventral skull base surgery: analysis of the National Surgical Quality Improvement Program

Singh

Siddiqui

Choi

et al. 2019

Int Forum Allergy Rhinol

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Background: Ventral skull base (VSB) surgery has associated morbidity and mortality that is poorly defined. In this study we aim to identify factors associated with adverse events in VSB surgery. Methods:We queried the database of the American College of Surgeons National Surgical Quality Improvement Program for cases of VSB surgery during the period 2005-2014. Patients with complications, readmissions, reoperations, or mortality were compared to those without adverse events.Results: Nine hundred patients were included; 253 (28.1%) had complications, underwent reoperation, were readmitted, or died. These patients were older (42.6% vs 32.8, p = 0.032) and had higher rates of congestive heart failure (CHF) (3.2% vs 0.2%, p < 0.0001), disseminated cancer (8.3% vs 4.6%, p = 0.032), and preoperative sepsis (8.7% vs 2.2%, p < 0.0001). Other comorbidities included longterm steroid use (13.4% vs 9.0%, p = 0.046) and higher rates of preoperative transfusion (2.4% vs 0%, p < 0.0001). The most common complication was bleeding (13.7%). Preoperative systemic sepsis (odds ratio [OR], 2.6; 95% confidence interval [CI], 1.0-6.6) and lower hematocrit (OR, 2.1; 95% CI, 1.4-3.4) were more likely to be associated with a com-plication. Those with disseminated cancer (OR, 12.0; 95% CI, 2.9-50.5) were more likely to experience 30-day mortality. Black patients had lower rates of reoperation (OR, 0.3; 95% CI, 0.1-0.8), whereas patients with CHF (OR, 12.6; 95% CI, 1.7-94.4) and hypertension (OR, 2.1; 95% CI, 1.1-4.0) had higher rates of reoperation. Predictors of extended length of stay were Hispanic ethnicity (OR, 2.2; 95% CI, 1.2-4.1) and lower hematocrit (OR, 2.3; 95% CI, 1.5-3.6).Conclusion: VSB surgery can involve significant morbidity and mortality, and thus identifying risk factors allows for be er prognostication and delivery of care in these patients. C 2019 ARS-AAOA, LLC.

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Section: Discussionsupporting

confidence: 86%

Morbidity and mortality associated with ventral skull base surgery: analysis of the National Surgical Quality Improvement Program

Singh

Siddiqui

Choi

et al. 2019

Int Forum Allergy Rhinol

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“…In recent years, we have witnessed the evolution and implementation of a variety of minimally invasive approaches that benefit from the use of endoscopy and that may avoid some of these issues, reduce morbidity, and speed recovery. These include the EEA 11,19,21,22,24,26,32,36 and the SKM performed via an eyebrow incision. 7,15,35,40 While attractive in theory, not all anterior skull base meningiomas are amenable to minimally invasive approaches, and there is a lack of consensus regarding case selection.…”

Section: Discussionmentioning

confidence: 99%

“…of reducing brain and nerve retraction, minimizing incision size and speeding patient recovery. These include the endoscopic endonasal approach (EEA) 11,19,21,22,24,26,32,36 and the supraorbital keyhole minicraniotomy (SKM) performed via an eyebrow incision with endoscopic assistance. 7,15,35,40 However, these approaches are not suitable for all meningiomas in this location and some still benefit from more extensive, more traditional approaches.…”

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confidence: 99%

Decision-making algorithm for minimally invasive approaches to anterior skull base meningiomas

Ottenhausen

Rumalla

Alalade

et al. 2018

Neurosurgical Focus

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OBJECTIVEAnterior skull base meningiomas are benign lesions that cause neurological symptoms through mass effect on adjacent neurovascular structures. While traditional transcranial approaches have proven to be effective at removing these tumors, minimally invasive approaches that involve using an endoscope offer the possibility of reducing brain and nerve retraction, minimizing incision size, and speeding patient recovery; however, appropriate case selection and results in large series are lacking.METHODSThe authors developed an algorithm for selecting a supraorbital keyhole minicraniotomy (SKM) for olfactory groove meningiomas or an expanded endoscopic endonasal approach (EEA) for tuberculum sella (TS) or planum sphenoidale (PS) meningiomas based on the presence or absence of olfaction and the anatomical extent of the tumor. Where neither approach is appropriate, a standard transcranial approach is utilized. The authors describe rates of gross-total resection (GTR), olfactory outcomes, and visual outcomes, as well as complications, for 7 subgroups of patients. Exceptions to the algorithm are also discussed.RESULTSThe series of 57 patients harbored 57 anterior skull base meningiomas; the mean tumor volume was 14.7 ± 15.4 cm3 (range 2.2–66.1 cm3), and the mean follow-up duration was 42.2 ± 37.1 months (range 2–144 months). Of 19 patients with olfactory groove meningiomas, 10 had preserved olfaction and underwent SKM, and preservation of olfaction in was seen in 60%. Of 9 patients who presented without olfaction, 8 had cribriform plate invasion and underwent combined SKM and EEA (n = 3), bifrontal craniotomy (n = 3), or EEA (n = 2), and one patient without both olfaction and cribriform plate invasion underwent SKM. GTR was achieved in 94.7%. Of 38 TS/PS meningiomas, 36 of the lesions were treated according to the algorithm. Of these 36 meningiomas, 30 were treated by EEA and 6 by craniotomy. GTR was achieved in 97.2%, with no visual deterioration and one CSF leak that resolved by placement of a lumbar drain. Two patients with tumors that, based on the algorithm, were not amenable to an EEA underwent EEA nonetheless: one had GTR and the other had a residual tumor that was followed and removed via craniotomy 9 years later.CONCLUSIONSUtilizing a simple algorithm aimed at preserving olfaction and vision and based on maximizing use of minimally invasive approaches and selective use of transcranial approaches, the authors found that excellent outcomes can be achieved for anterior skull base meningiomas.

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“…[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15] Indeed, as stated by Khan et al, careful case selection and surgical experience are the most relevant prognostic factors in endonasal endoscopic skull base meningioma surgery. [18][19][20][21] Particularly, this approach should be reserved to strictly midline tumors, with no encasement of major vessels. 22 Some Authors have proposed the presence of brain edema and the lack of cortical cuff as 2 other relevant parameters in patients' selection for this surgery.…”

Section: Discussionmentioning

confidence: 99%

The Endoscopic Endonasal Management of Anterior Skull Base Meningiomas

et al. 2018

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The endoscopic endonasal approach (EEA) might seem an "unnatural" route for intradural lesions such as meningiomas. The aim of this study is to critically revise our management of anterior skull base meningiomas to consider, in what cases it may be advantageous. Each consecutive case of anterior skull base meningioma operated on through an EEA or combined endoscopic-transcranial approach at our institution, between 2003 and 2017, have been included. Tumors were classified on the basis of their location and intra or extracranial extension. Follow-up consisted of an MRI (magnetic resonance imaging) and a clinical examination 3 months after the surgery and then repeated annually. Fifty-seven patients were included. The most common location was the tuberculum sellae (62%), followed by olfactory groove (14%), planum sphenoidale (12%), and frontal sinus (12%). Among these, 65% were intracranial, 7% were extracranial, and 28% both intra and extracranial. Radical removal was achieved in 44 cases (77%). Complications consisted in 10 CSF (cerebrospinal fluid) leaks (17.6%), 1 overpacking (1.7%), and 1 asymptomatic brain ischemia (1.7%). Visual acuity and campimetric deficits improved respectively in 67 and 76% of patients. Recurrence rate was of 14%. EEA presents many advantages in selected cases of anterior skull base meningioma. However, it is hampered by the relevant risk of CSF leak. We consider that it could be advantageous for planum/tuberculum sellae tumors. Conversely, for olfactory groove or frontal sinus meningiomas, it can be indicated for tumors with extracranial extension, while its role is still debatable for purely intracranial forms as considering our surgical results, it could be advantageous for midline planum/tuberculum sellae tumors. Conversely, it can be of first choice for olfactory groove or frontal sinus meningiomas with extracranial extension, while its role for purely intracranial forms is still debatable.

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The Impact of Age on Long-Term Quality of Life After Endonasal Endoscopic Resection of Skull Base Meningiomas

Abstract: ASBQ, Anterior Skull Base QuestionnaireGTR, gross total resectionQOL, quality of lifeSNOT-22, 22-item Sino-Nasal Outcome Test.

Cited by 35 publications

References 53 publications

Morbidity and mortality associated with ventral skull base surgery: analysis of the National Surgical Quality Improvement Program

Morbidity and mortality associated with ventral skull base surgery: analysis of the National Surgical Quality Improvement Program

Decision-making algorithm for minimally invasive approaches to anterior skull base meningiomas

The Endoscopic Endonasal Management of Anterior Skull Base Meningiomas

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