Abstract
Anterior skull base meningiomas are benign, dural-based tumors that originate from the tuberculum sellae, planum sphenoidale or olfactory groove. A multitude of traditional transcranial approaches have been effectively used for resection of these tumors. However, in the era of minimally invasive neurosurgery, the endoscopic endonasal and the endoscope-assisted or endoscope-controlled supraorbital keyhole eyebrow approaches stand out as the two main options utilized to resect these tumors. The supraorbital keyhole approach minimizes brain retraction, tissue dissection and length of the skin incision. Consequently, this approach is associated with a lower complication profile and much better cosmetic results in comparison to classic approaches. With endoscopic assistance or control, the approach provides an excellent view of anterior skull base meningiomas and enables optic nerve decompression when angled scopes are used. In our opinion, endoscopes will ultimately replace the surgical microscopes as the viewing tools in this type of surgery. A limited number of studies have directly compared the endoscopic endonasal approach versus the supraorbital keyhole one for resection of anterior cranial base meningiomas. In these studies, scores and algorithms have been suggested to help select the suitable approach. The practical value of these algorithms still needs to be validated by further research. Although the endoscope-assisted or -controlled supraorbital keyhole approach offers a minimally invasive and highly effective approach for excision of anterior cranial base meningiomas, the ideal approach should be tailored to the individual patient according to the tumor size, lateral extension, optic canal involvement, extent of vascular encasement and surgeon’s experience.
Highlights
Anterior skull base meningiomas are benign, dural-based tumors that originate from the tuberculum sellae, planum sphenoidale or olfactory groove which includes the lamina cribrosa and frontoethmoidal suture
Olfactory groove meningiomas account for 8%-13% of all intracranial meningiomas[1,2,3], while tuberculum sellae and planum sphenoidale meningiomas constitute around 10%-15% of meningiomas and often present with visual disturbance due to compression of the optic nerves and chiasm[4,5] [Figure 1]
Minimally invasive approaches for surgical excision of anterior skull base meningiomas include the endoscopic endonasal approach[11,12,13,14] and the endoscope-assisted or endoscope-controlled supraorbital keyhole eyebrow approach . [7,15,16,17,18,19] In this article, the endoscope-assisted or endoscope-controlled supraorbital keyhole eyebrow approaches for anterior cranial base meningiomas will be briefly elaborated upon
Summary
Anterior skull base meningiomas are benign, dural-based tumors that originate from the tuberculum sellae, planum sphenoidale or olfactory groove which includes the lamina cribrosa and frontoethmoidal suture. For tuberculum sellae and planum sphenoidale meningiomas, surgical resection results in decompression of the optic nerves and chiasm and prevents further visual deterioration and may reverse neural damage in some cases[10]. Minimally invasive approaches for surgical excision of anterior skull base meningiomas include the endoscopic endonasal approach[11,12,13,14] and the endoscope-assisted or endoscope-controlled supraorbital keyhole eyebrow approach .
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