Hostname: page-component-74d7c59bfc-d4pbl Total loading time: 0 Render date: 2026-01-31T15:51:49.056Z Has data issue: false hasContentIssue false
  • English
  • Français

Clinical Outcomes of Extended Endoscopic Endonasal Approach for the Resection of Anterior Skull Base Meningiomas

Published online by Cambridge University Press:  20 November 2025

Alejandro Vargas-Moreno Open the ORCID record for Alejandro Vargas-Moreno [Opens in a new window] ,
Sami Khairy ,
Mouaz Saymeh ,
Wareef W. AlGhamdi ,
Jessica Rabski ,
Shaun Kilty ,
Damanpreet Lang Open the ORCID record for Damanpreet Lang [Opens in a new window]  and
Fahad AlKherayf
Alejandro Vargas-Moreno*
Affiliation:
Division of Neurosurgery, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
Sami Khairy
Affiliation:
Division of Neurosurgery, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
Mouaz Saymeh
Affiliation:
The Ottawa Hospital Research Institute, Ottawa, ON, Canada
Wareef W. AlGhamdi
Affiliation:
College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
Jessica Rabski
Affiliation:
Division of Neurosurgery, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada
Shaun Kilty
Affiliation:
Department of Otolaryngology - Head & Neck Surgery, University of Ottawa, Ottawa, ON, Canada
Damanpreet Lang
Affiliation:
The Ottawa Hospital Research Institute, Ottawa, ON, Canada
Fahad AlKherayf
Affiliation:
Division of Neurosurgery, Department of Surgery, The Ottawa Hospital, Ottawa, ON, Canada The Ottawa Hospital Research Institute, Ottawa, ON, Canada
*
Corresponding author: Alejandro Vargas-Moreno; Email: alejandrovargasmor@gmail.com
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

Anterior skull base meningiomas account for 6% to 13% of all meningiomas. The extended endoscopic endonasal approach (EEA) to these meningiomas offers many advantages such as early devascularization, adequate tumor resection and preservation of neurovascular structures. This study aims to evaluate the clinical outcomes of patients undergoing EEA for anterior skull base meningiomas, including recurrence rate and prognostic factors.

Methods:

This is a retrospective study conducted on adult patients who underwent EEA for anterior skull base meningiomas at The Ottawa Hospital Civic Campus between October 2014 and October 2023.

Results:

Twenty-five patients underwent EEA for anterior skull base meningiomas. The mean preoperative tumor volume was significantly larger in the olfactory groove (OG) group (19.54 cm3) compared to the tuberculum sellae (TS) group (7.04 cm3). Mean surgical duration was 351 minutes, and mean blood loss was 472 ml. A nasoseptal flap was used in 92% of cases. CSF leaks occurred in four cases (16%) and were managed with lumbar drainage. Total or near-total resection was achieved in 87.5% of OG cases and 82.4% of TS cases. Subtotal resections were significantly associated with larger tumor volumes (p = 0.03). Most of our cohort’s histopathological findings were World Health Organization grade I meningiomas (92%). Our mean follow-up was 5.56 years and tumor recurrence was seen in one patient.

Conclusion:

Extended EEA for anterior skull base meningiomas is a safe and effective technique enabling total resection with a low recurrence rate. Optimal patient selection and multilayered reconstruction are critical to minimize complications.

Résumé

RÉSUMÉ

Évolution de l’état clinique de patients ayant bénéficié de l’approche endonasale endoscopique étendue à la résection des méningiomes de la base du crâne antérieure.

Introduction :

Les méningiomes de la base du crâne antérieure représentent 6 % à 13 % de tous les méningiomes. L’approche endonasale endoscopique (AEE) étendue à ces méningiomes offre de nombreux avantages : dévascularisation précoce, résection adéquate de la tumeur et préservation des structures neurovasculaires. Cette étude vise à évaluer l’évolution de l’état clinique de patients ayant bénéficié de l’AEE pour des méningiomes de la base du crâne antérieure, de même que les récidives et les facteurs pronostiques.

Méthodes :

Il s’agit d’une étude rétrospective menée auprès de patients adultes ayant bénéficié, au campus Civic de l’Hôpital d’Ottawa entre octobre 2014 et octobre 2023, d’une AEE pour des méningiomes de la base du crâne antérieure.

Résultats :

Au total, ce sont 25 patients qui ont bénéficié d’une AEE pour des méningiomes de la base du crâne antérieure. Le volume tumoral moyen préopératoire était notablement plus important dans le groupe du sillon olfactif (19,54 cm³) que dans le groupe du tubercule sellaire (7,04 cm³). La durée moyenne de l’intervention était de 351 minutes et la perte sanguine moyenne était de 472 ml. Un lambeau nasoseptal a été utilisé dans 92 % des cas. Des fuites de liquide céphalo-rachidien (LCR) sont survenues dans quatre cas (16 %) et ont été traitées par drainage lombaire. Une résection totale ou quasi totale a été effectuée dans 87,5 % des cas du groupe du sillon olfactif et dans 82,4 % des cas du groupe du tubercule sellaire. Les résections subtotales étaient significativement associées à des volumes tumoraux plus importants (p = 0,03). La plupart des résultats histopathologiques au sein de notre cohorte étaient des méningiomes de grade I selon l’OMS (92 %). Enfin, notre suivi moyen était de 5,56 ans alors qu’une récidive tumorale a été observée chez un patient.

Conclusion :

L’AEE étendue aux méningiomes de la base du crâne antérieure est une technique sûre et efficace permettant une résection totale avec un faible taux de récidive. Une sélection optimale des patients et une reconstruction multicouche (multilayered reconstruction) sont aussi essentielles pour minimiser les complications.

Keywords

anterior skull base meningiomasextended endoscopic endonasal approachOlfactory groovetubercullum sellaeanterior skull base

Information

Type
Original Article
Information
Canadian Journal of Neurological Sciences , First View , pp. 1 - 6
Copyright
© The Author(s), 2025. Published by Cambridge University Press on behalf of Canadian Neurological Sciences Federation

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Article purchase

Temporarily unavailable

References

McDermott, MW, Wilson, CB. Meningiomas. In: Youmans, J, ed. Neurological Surgery, 4th ed. WB Saunders; 1996: 2782–2825.Google Scholar
Solero, CL, Giombini, S, Morello, G. Suprasellar and olfactory meningiomas. Report on a series of 153 personal cases. Acta Neurochir (Wien). 1983;67(3–4):181–194.Google Scholar
Woodworth, GF. Endoscopic management of anterior cranial fossa meningiomas. Oper Tech Otolayngol Head Neck Surg. 2011;22(4):254–262. DOI: 10.1016/j.otot.2011.08.006.Google Scholar
de Divitiis, E, Cappabianca, P, Cavallo, LM. Endoscopic transsphenoidal approach: adaptability of the procedure to different sellar lesions. Neurosurgery. 2002;51:699–707.Google Scholar
Kassam, A, Carrau, RL, Snyderman, CH, Gardner, P, Mintz, A. Evolution of reconstructive techniques following endoscopic expanded endonasal approaches. Neurosurg Focus. 2005;19:E8.Google Scholar
Zoli, M, Guaraldi, F, Pasquini, E, Frank, G, Mazzatenta, D. The endoscopic endonasal management of anterior skull base meningiomas. J Neurol Surg B Skull Base. 2018;79:S300–S310. DOI: 10.1055/s-0038-1669463.Google Scholar
Kshettry, VR, Elshazly, K, Evans, JJ. Endoscopic transnasal surgery for planum and tuberculum sella meningiomas: decision-making, technique and outcomes. CNS Oncol. 2016;5(04):211–222. DOI: 10.2217/cns-2016-0007.Google Scholar
Joiner, MC, van der Kogel, A. Basic Clinical Radiobiology, 5th edn. Taylor & Francis; 2016.Google Scholar
Chmielewski, PP. New terminologia anatomica: cranium and extracranial bones of head. Folia Morpholog. 2019;80:477–486. DOI: 10.5603/FM.a2019.0129.Google Scholar
Dehdashti, AR, Ganna, A, Witterick, I, Gentili, F. Expanded endoscopic endonasal approach for anterior cranial base and suprasellar lesions: indications and limitations. Neurosurgery. 2009;64(4):677–687; discussion 687-9. DOI: 10.1227/01.NEU.0000339121.20101.85.Google Scholar
Har-El, G, Casiano, RR. Endoscopic management of anterior skull base tumors. Otolaryngol Clin North Am. 2005;38(1):133–144, ix. DOI: 10.1016/j.otc.2004.09.007.Google Scholar
De Divitiis, E, Esposito, F, Cappabianca, P, Cavallo, LM, de Divitiis, O. Tuberculum sellae meningiomas high route or low route a series of 51 consecutive cases. Neurosurgery. 2008;62(3):556–63; discussion 556–63. DOI: 10.1227/01.neu.0000317303.93460.24.Google Scholar
Liu, JK, Christiano, LD, Patel, SK, Tubbs, RS, Eloy, JA. Surgical nuances for removal of tuberculum sellae meningiomas with optic canal involvement using the endoscopic endonasal extended transsphenoidal transplanum transtuberculum approach. Neurosurg Focus. 2011;30(5):E2. DOI: 10.3171/2011.3.focus115.Google Scholar
Bowers, CA, Altay, T, Couldwell, WT. Surgical decision-making strategies in tuberculum sellae meningioma resection. Neurosurg Focus. 2011;30:E1. DOI: 10.3171/2011.2.focus1115.Google Scholar
Raco, A, Bristot, R, Domenicucci, M, Cantore, G. Meningiomas of the tuberculum sellae. Our experience in 69 cases surgically treated between 1973 and 1993. J Neurosurg Sci. 1999;43(4):253–260; discussion 260–2.Google Scholar
Plou, P, Serioli, S, Leonel, LCPC, et al. Surgical anatomy and approaches of the anterior cranial Fossa from a transcranial and endonasal perspective. Cancers (Basel). 2023;15(9):2587. DOI: 10.3390/cancers15092587.Google Scholar
Kassam, A, Snyderman, CH, Mintz, A, Gardner, P, Carrau, RL. Expanded endonasal approach: the rostrocaudal axis. Part I. Crista galli to the sella turcica. Neurosurg Focus. (2005);19(1):E3.Google Scholar
Borghei-Razavi, H, Eguiluz-Melendez, A, Wenping, X, et al. Surgical limitations of the microscopic transciliary supraorbital keyhole approach to the anterior and middle skull base. World Neurosurg. 2022;167:e1440–e1447. DOI: 10.1016/j.wneu.2022.09.071.Google Scholar
Schroeder, HW. Indications and limitations of the endoscopic endonasal approach for anterior cranial base meningiomas. World Neurosurg. 2014;82(6 Suppl):S81–S85. DOI: 10.1016/j.wneu.2014.07.030.Google Scholar
Hentschel, SJ, DeMonte, F. Olfactory groove meningiomas. Neurosurg Focus. 2003;14:E4.Google Scholar
Jang, WY, Jung, S, Jung, TY, Moon, KS, Kim, IY. Preservation of olfaction in surgery of olfactory groove meningiomas. Clin Neurol Neurosurg. 2013;115:1288–1292.Google Scholar
Koutourousiou, M, Fernandez-Miranda, JC, Wang, EW, Snyderman, CH, Gardner, PA. Endoscopic endonasal surgery for olfactory groove meningiomas: outcomes and limitations in 50 patients. Neurosurg Focus. 2014;37(4):E8. DOI: 10.3171/2014.7.focus14330.Google Scholar
Eloy, JA, Shukla, PA, Choudhry, OJ, Singh, R, Liu, JK. Assessment of frontal lobe sagging after endoscopic endonasal transcribriform resection of anterior skull base tumors: is rigid structural reconstruction of the cranial base defect necessary? Laryngoscope. 2012;122:2652–2657. DOI: 10.1002/lary.23539.Google Scholar
Schick, U. Surgical management of tuberculum sellae meningiomas: involvement of the optic canal and visual outcome. J Neurol Neurosurg Psychiatry. 2005;76(7):977–983. DOI: 10.1136/jnnp.2004.039974.Google Scholar
Mahmoud, M, Nader, R, Al-Mefty, O. Optic canal involvement in tuberculum sellae meningiomas: influence on approach, recurrence, and visual recovery. Oper Neurosurg. 2010;67(3):ons108–ons119. DOI: 10.1227/01.neu.0000383153.75695.24.Google Scholar
Sankhla, S, Jayashankar, N, Khan, M, Khan, G. Surgical management of tuberculum sellae meningioma: our experience and review of the literature. Neurol India. 2021;69(6):1592. DOI: 10.4103/0028-3886.333529.Google Scholar
Jallo, GI, Benjamin, V. Tuberculum sellae meningiomas: microsurgical anatomy and surgical technique. Neurosurgery. 2002;51(6):1432–1439; discussion 1439–40. DOI: 10.1097/00006123-200212000-00013.Google Scholar
Magill, ST, Morshed, RA, Lucas, CG, et al. Tuberculum sellae meningiomas: grading scale to assess surgical outcomes using the transcranial versus transsphenoidal approach. Neurosurg Focus. 2018;44(4):E9. DOI: 10.3171/2018.1.focus17753.Google Scholar
Laufer, I, Anand, VK, Schwartz, TH. Endoscopic, endonasal extended transsphenoidal, transplanum transtuberculum approach for resection of suprasellar lesions. J Neurosurg. 2007;106(3):400–406. DOI: 10.3171/jns.2007.106.3.400.Google Scholar