The Endoscopic-Assisted Supraorbital Approach for Resection of Anterior Skull Base Meningiomas: A Large Single-Center Retrospective Surgical Study

Author:

Serrano Sponton Lucas12,Oehlschlaegel Florian23,Nimer Amr24,Schwandt Eike2,Glaser Martin2,Archavlis Eleftherios2,Conrad Jens2,Kantelhardt Sven2,Ayyad Ali256

Affiliation:

1. Department of Neurosurgery, Sana Klinikum Offenbach, Offenbach am Main, Germany

2. Department of Neurosurgery, Mainz University Medical Centre, Mainz, Germany

3. Department of Neurosurgery, Helios Amper Clinic, Dachau, Germany, Germany

4. Department of Neurosurgery, Charing Cross Hospital, Imperial College Healthcare, London, United Kingdom

5. Department of Neurosurgery, Hamad General Hospital, Doha, QATAR

6. Department of Neurosurgery, Saarland University Medical Centre, Homburg, Germany

Abstract

Abstract Objective The endoscopic-assisted supraorbital approach (eSOA) constitutes a minimally invasive strategy for removing anterior skull base meningiomas (ASBM). We present the largest retrospective single-institution and long-term follow-up study of eSOA for ASBM resection, providing further insight regarding indication, surgical considerations, complications, and outcome. Methods We evaluated data of 176 patients operated on ASBM via the eSOA over 22 years. Results Sixty-five tuberculum sellae (TS), 36 anterior clinoid (AC), 28 olfactory groove (OG), 27 planum sphenoidale, 11 lesser sphenoid wing, seven optic sheath, and two lateral orbitary roof meningiomas were assessed. Median surgery duration was 3.35 ± 1.42 hours, being significantly longer for OG and AC meningiomas (p <0.05). Complete resection was achieved in 91%. Complications included hyposmia (7.4%), supraorbital hypoesthesia (5.1%), cerebrospinal fluid fistula (5%), orbicularis oculi paresis (2.8%), visual disturbances (2.2%), meningitis (1.7%) and hematoma and wound infection (1.1%). One patient died due to intraoperative carotid injury, other due to pulmonary embolism. Median follow-up was 4.8 years with a tumor recurrence rate of 10.8%. Second surgery was chosen in 12 cases (10 via the previous SOA and two via pterional approach), whereas two patients received radiotherapy and in five patients a wait-and-see strategy was adopted. Conclusion The eSOA represents an effective option for ASBM resection, enabling high complete resection rates and long-term disease control. Neuroendoscopy is fundamental for improving tumor resection while reducing brain and optic nerve retraction. Potential limitations and prolonged surgical duration may arise from the small craniotomy and reduced maneuverability, especially for large or strongly adherent lesions.

Publisher

Georg Thieme Verlag KG

Subject

Neurology (clinical)

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