Abstract
Simple SummaryResectioning midline meningiomas of the anterior skull base such as olfactory groove, planum sphenoidale, or tuberculum sellae is challenging, and determining the appropriate approach is important. Based on our experience with midline meningiomas, we propose a decision algorithm for choosing suitable transcranial approaches. With dichotomizing classic skull bases approaches into median and lateral ones, we display that median approaches provide satisfactory results for olfactory groove meningiomas, whereas lateral approaches enable sufficient exposure of the visual apparatus for planum sphenoidale meningiomas or tuberculum sellae meningiomas. This manuscript aims to point out the sufficiency and feasibility of classic transcranial techniques.(1) Background: Midline meningiomas such as olfactory groove (OGMs), planum sphenoidale (PSMs), or tuberculum sellae meningiomas (TSMs) are challenging, and determining the appropriate approach is important. We propose a decision algorithm for choosing suitable transcranial approaches. (2) Methods: A retrospective chart review between 06/2007 and 01/2020. Clinical outcomes, radiographic findings, and postoperative complication rates were analyzed with respect to operative approaches. (3) Results: We included 88 patients in the analysis. Of these, 18.2% (16/88) underwent an interhemispheric approach, 72.7% (64/88) underwent a pterional/frontolateral/supraorbital approach, 2.3% (2/88) underwent a unilateral subfrontal approach, and 6.8% (6/88) underwent a bifrontal approach. All OGMs underwent median approaches, along with one PSM. All of the other PSMs and TSMs were resected via lateral approaches. The preoperative tumor volume was ∅20.2 ± 27.1 cm3. Median approaches had significantly higher tumor volume but also higher rates of Simpson I resection (75.0% vs. 34.4%). An improvement of visual deficits was observed in 34.1% (30/88). The adverse event rate was 17.0%. Median follow-up was 15.5 months (range 0–112 months). (4) Conclusions: Median approaches provides satisfying results for OGMs, lateral approaches enable sufficient exposure of the visual apparatus for PSMs and TSMs. In proposing a simple decision-making algorithm, the authors found that satisfactory outcomes can be achieved for midline meningiomas.
Highlights
Meningiomas of the anterior skull base are complex lesions due to local bone invasion and the invasion of adjacent neural and vascular structures
We investigate the extent of resection along with the clinical outcomes and adverse events in a large cohort of patients with midline meningiomas of the anterior skull base at a single tertiary center who underwent classic transcranial approaches
Infiltration of orbit/optic nerve/chiasmatic structures. Based on these and previously mentioned findings, we developed an algorithm for choosing. Based on these and previously mentioned findings, we developed an algorithm for choosing median and lateral approaches (Figure 2)
Summary
Meningiomas of the anterior skull base are complex lesions due to local bone invasion and the invasion of adjacent neural and vascular structures. Other treatment modalities include radiation (including proton beam therapy) and devascularization via catheter embolization Various classic approaches such as the pterional, frontolateral, supraorbital, subfrontal, bifrontal, and interhemispheric approaches have been described as achieving an optimal visualization of the situs [1,3,4,5,6,7,8,9]. (4) Conclusions: Median approaches provides satisfying results for OGMs, lateral approaches enable sufficient exposure of the visual apparatus for PSMs and TSMs. In proposing a simple decision-making algorithm, the authors found that satisfactory outcomes can be achieved for midline meningiomas
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