Residual and Recurrent Disease Following Endoscopic Endonasal Approach as a Reflection of Anatomic Limitation for the Resection of Midline Anterior Skull Base Meningiomas

Oper Neurosurg (Hagerstown). 2021 Sep 15;21(4):207-216. doi: 10.1093/ons/opab244.


Background: Endoscopic endonasal approaches (EEAs) to anterior skull base meningiomas have grown in popularity, though anatomic limitations remain unclear.

Objective: To show the anatomic limits of EEA for meningiomas.

Methods: Retrospective chart review for all patients that underwent EEA for anterior skull base meningiomas from 2005 to 2014.

Results: A total of 100 patients averaged follow-up of 46.9 mo (24-100 mo). A total of 35 patients (35%) had olfactory groove, 33 planum sphenoidale (33%), and 32 tuberculum sella (32%) meningiomas. The average diameter was 2.9 cm (0.5-8.1 cm). Vascular encasement was seen in 11 patients (11%) and calcification in 20 (20%). Simpson Grade 1 (SG1) resection was achieved in 64 patients (64%). Only calcification impacted degree of resection (40% SG1, P = .012). The most common residual was on the anterior clinoid dura (11 patients [11%]). Six (6%) had residual superior/lateral to the optic nerve. Residual tumor was adherent to the optic apparatus or arteries in 5 patients (5%) each, and 3 patients (3%) had residual lateral to the mid-orbit. Rates of residual decreased over time. A total of 11 patients (11%) had tumor recurrence (mean of 40 mo): 4 (4%) on the anterior clinoid, 2 (2%) each on the lateral orbital roof, adherent to optic apparatus and superolateral to the optic nerve, and 1 (1%) was at the anterior falx.

Conclusion: Anterior skull base meningiomas can effectively be approached via EEA in most patients; tumors extending to the anterior clinoid, anterior falx, or superolateral to the optic nerve or orbital roof, especially if calcified, may be difficult to reach via EEA.

Keywords: Anterior skull base; Endoscopic endonasal; Meningioma; Skull base surgery.

MeSH terms

  • Cranial Fossa, Anterior / surgery
  • Humans
  • Meningeal Neoplasms* / diagnostic imaging
  • Meningeal Neoplasms* / surgery
  • Meningioma* / diagnostic imaging
  • Meningioma* / surgery
  • Neoplasm Recurrence, Local / surgery
  • Neurosurgical Procedures
  • Retrospective Studies
  • Treatment Outcome