Total resection of recurrent meningothelial meningioma through a combined transcranial.endonasal approach

Orestes López Piloto,Yurledys Jhohana Linares Benavides

doi:10.31579/2578-8868/106

Abstract

Objective: To evaluate the efficacy of combining an endonasal endoscopic approach and transcranial approach in a patient with a recurrent olfactory cleft meningothelial meningioma. Case report: A 57-years-old female caucasian patient was referred to our institution with a previous history hypertension and a right frontal craniotomy for a World Health Organization (WHO) grade I meningioma with 70% removal of the lesion. A second frontal craniotomy was performed with a 95% resection of the tumor. She received adjuvant treatment with Conformal Radiotherapy (30 sessions) and Nimotuzumab (33 doses). Seven months after was treated surgically for a bone flap osteomyelitis with removal of the bone flap. An endonasal endoscopic transcribiform approach was performed with a partial removal of the lesion. Few weeks after the patient started again with frontobasal soft tissue growing and frontal headache. CT and RMI scans showed regrowing of the tumor. A combined simultaneous endonasal endoscopic approach-transcraneal approach through bilateral frontal craniotomy was performed. There were not transoperative or postoperative complications. The hospital stay was 9 days. Conclusions: Olfactory groove meningiomas can extend into the paranasal sinuses. The cranial base and paranasal sinuses are the most common sites of tumor recurrence even after gross total resection. Radical tumor resection, by a combined endonasal and transcranial approach is the best way to reduce the chances of recurrence.

Highlights

F: Coronal and axial view of the tumorBecause of the large size of the tumor mass extending into the ethmoidsphenoidal complex, a combined simultaneous endonasal endoscopic approach-transcraneal approach through bilateral frontal craniotomy was performed
Case report: A 57-years-old female caucasian patient was referred to our institution with a previous history hypertension and a right frontal craniotomy for a World Health Organization WHO grade I meningioma with 70% removal of the lesion
The tumor reaches the paranasal sinuses and nasal cavity by a direct extension and erosion of the bone barrier [2].The paranasal sinuses are not commonly the primary location of a meningioma [3]. Because this tumor arise from the region of the cribriform plate and the planum sphenoidale, they are in direct relation to the ethmoid and sphenoid sinuses

Summary

F: Coronal and axial view of the tumor

Because of the large size of the tumor mass extending into the ethmoidsphenoidal complex, a combined simultaneous endonasal endoscopic approach-transcraneal approach through bilateral frontal craniotomy was performed. Ceftriaxone was administered via the intravenous route within 1 hour before surgery (1.5 g) and continued for 5 post-operatively (1.5 g twice a day) until nasal packing (Foley balloon) were removed. Base exposure during the endonasal approach and the frontal lobe retraction during the transcranial approach. A secondary incision was made in the left nasoorbital region in order to remove the facial component of the tumor. The resulting skull base defect was reconstructed by using a multilayer technique with fat, fascia lata and pericranium under endoscopic visualization. A Foley catheter balloon maintained the nasoseptal flap until the fifth day postoperative when it was removed.

Discussion

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Conclusion