Endoscopic Endonasal Approach to Primitive Meckel's Cave Tumors: A Clinical Series

Acta Neurochir (Wien). 2018 Dec;160(12):2349-2361. doi: 10.1007/s00701-018-3708-4. Epub 2018 Oct 31.

Abstract

Introduction: Recently, an alternative endoscopic endonasal approach to Meckel's cave (MC) tumors has been proposed. To date, few studies have evaluated the results of this route. The aim of our study was to evaluate long-term surgical and clinical outcome associated with this technique in a cohort of patients with intrinsic MC tumors.

Methods: All patients with MC tumors treated at out institution by endoscopic endonasal approach (EEA) between 2002 and 2016 were included. Patients underwent brain MRI, CT angiography, and neurological evaluation before surgery. Complications were considered based on the surgical records. All examinations were repeated after 3 and 12 months, then annually. The median follow-up was of 44.1 months (range 16-210).

Results: The series included 8 patients (4 F): 5 neuromas, 1 meningioma, 1 chondrosarcoma, and 1 epidermoid cyst. The median age at treatment was 54.5 years (range 21-70). Three tumors presented with a posterior fossa extension. Radical removal of the MC portion of the tumor was achieved in 7 out of 8 cases. Two patients developed a permanent and transitory deficit of the sixth cranial nerve, respectively. No tumor recurrence was observed at follow-up.

Conclusion: In this preliminary series, the EEA appeared an effective and safe approach to MC tumors. The technique could be advantageous to treat tumors located in the antero-medial aspects of MC displacing the trigeminal structures posteriorly and laterally. A favorable index of an adequate working space for this approach is represented by the ICA medialization, while tumor extension to the posterior fossa represents the main limitation to radical removal of this route.

Keywords: Endoscopic endonasal surgery; Gasserian ganglion; Meckel’s cave; Meningiomas; Schwannomas; Trigeminal nerve.

Publication types

  • Case Reports

MeSH terms

  • Adult
  • Aged
  • Female
  • Humans
  • Male
  • Meningeal Neoplasms / surgery*
  • Meningioma / surgery*
  • Middle Aged
  • Natural Orifice Endoscopic Surgery / adverse effects
  • Natural Orifice Endoscopic Surgery / methods*
  • Nose / surgery
  • Postoperative Complications / epidemiology*