Expanded endonasal endoscopic resection of anterior fossa meningiomas: Report of 13 cases and meta-analysis of the literature

Jamie Van Gompel, Giorgio Frank, Ernesto Pasquini, Matteo Zoli, Jason Hoover, Giuseppe Lanzino

Research output: Contribution to journalArticle

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Abstract

Object: Transnasal endoscopic (TNE) approaches have been proposed for the resection of anterior cranial base meningiomas. The purpose of this article was to evaluate the results of endoscopic resection of anterior cranial fossa meningiomas by reviewing available published data in addition to the authors' experience with 13 cases. Methods: The literature was searched via OVID to identify all available disaggregate data pertaining to anterior fossa meningiomas treated primarily by TNE. In addition, the authors reviewed the records of a personal series of 13 patients who underwent TNE removal of parasellar meningiomas through a pure TNE approach. Results: Meta-analysis from studies included a total of 69 patients with adequate disaggregated data to summarize. Mean age (± SD) at surgery was 53.3 ± 13.0 years (range 27-80 years); 78% of the patients were women. Tumor size was skewed toward smaller lesions, with a mean volume of 24.4 ± 2.9 cm 3. Intraoperative impressions were of gross-total resection in 76% of cases. The most common complication reported was CSF leakage, occurring in 32% of the cases (22 of 69). The rate of CSF leakage was not affected by size (p = 0.52), location of tumor (p = 0.9), or age (p = 0.56). There was 1 death overall. The mean duration of follow-up was 21 ± 18 months. Conclusions: Transnasal endoscopic resection of anterior cranial base meningiomas is feasible in selected cases. Reported resection rates are adequate, although the follow-up in the reported series is too short (mean 21 months) to make definitive conclusions regarding the long-term effectiveness. Cerebrospinal fluid leakage is a common complication, although it appears not to be associated with additional morbidity except for the need for reoperation. Long-term results are necessary before considering TNE resection as a valid alternative, in selected cases, to the more established transcranial techniques.

Original languageEnglish (US)
Article numberE15
JournalNeurosurgical Focus
Volume30
Issue number5
DOIs
StatePublished - May 2011

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Meningioma
Meta-Analysis
Skull Base
Anterior Cranial Fossa
Reoperation
Neoplasms
Morbidity

Keywords

  • Endonasal approach
  • Endoscopic approach
  • Meningioma
  • Neurosurgery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Expanded endonasal endoscopic resection of anterior fossa meningiomas : Report of 13 cases and meta-analysis of the literature. / Van Gompel, Jamie; Frank, Giorgio; Pasquini, Ernesto; Zoli, Matteo; Hoover, Jason; Lanzino, Giuseppe.

In: Neurosurgical Focus, Vol. 30, No. 5, E15, 05.2011.

Research output: Contribution to journalArticle

Van Gompel, Jamie ; Frank, Giorgio ; Pasquini, Ernesto ; Zoli, Matteo ; Hoover, Jason ; Lanzino, Giuseppe. / Expanded endonasal endoscopic resection of anterior fossa meningiomas : Report of 13 cases and meta-analysis of the literature. In: Neurosurgical Focus. 2011 ; Vol. 30, No. 5.
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abstract = "Object: Transnasal endoscopic (TNE) approaches have been proposed for the resection of anterior cranial base meningiomas. The purpose of this article was to evaluate the results of endoscopic resection of anterior cranial fossa meningiomas by reviewing available published data in addition to the authors' experience with 13 cases. Methods: The literature was searched via OVID to identify all available disaggregate data pertaining to anterior fossa meningiomas treated primarily by TNE. In addition, the authors reviewed the records of a personal series of 13 patients who underwent TNE removal of parasellar meningiomas through a pure TNE approach. Results: Meta-analysis from studies included a total of 69 patients with adequate disaggregated data to summarize. Mean age (± SD) at surgery was 53.3 ± 13.0 years (range 27-80 years); 78{\%} of the patients were women. Tumor size was skewed toward smaller lesions, with a mean volume of 24.4 ± 2.9 cm 3. Intraoperative impressions were of gross-total resection in 76{\%} of cases. The most common complication reported was CSF leakage, occurring in 32{\%} of the cases (22 of 69). The rate of CSF leakage was not affected by size (p = 0.52), location of tumor (p = 0.9), or age (p = 0.56). There was 1 death overall. The mean duration of follow-up was 21 ± 18 months. Conclusions: Transnasal endoscopic resection of anterior cranial base meningiomas is feasible in selected cases. Reported resection rates are adequate, although the follow-up in the reported series is too short (mean 21 months) to make definitive conclusions regarding the long-term effectiveness. Cerebrospinal fluid leakage is a common complication, although it appears not to be associated with additional morbidity except for the need for reoperation. Long-term results are necessary before considering TNE resection as a valid alternative, in selected cases, to the more established transcranial techniques.",
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