Endoscopic Endonasal Resection of Skull Base Meningiomas

Czech version

Authors: D. Netuka ¹; V. Masopust ¹; T. Belšan ²; F. Kramář ¹; V. Hána ³; V. Beneš ¹
Authors‘ workplace: Neurochirurgická klinika 1. LF UK a ÚVN – Vojenská fakultní nemocnice Praha ¹; Radiologické oddělení, ÚVN – Vojenská fakultní nemocnice Praha ²; III. interní klinika 1. LF UK a VFN v Praze ³
Published in: Cesk Slov Neurol N 2013; 76/109(4): 446-452
Category: Original Paper

Podpořeno IGA MZ NT 14256.

Overview

Study aim:
Endoscopic technique enables endonasal surgery of non‑pituitary skull base lesions. Several cases of endonasal resection of the skull base meningiomas have been described.

Methods and material:
At our institution, 614 endoscopic endonasal procedures were performed untill June 2012. Intraoperative MRI was performed in 409 cases. We conducted an analysis of all endoscopic endonasal procedures for the skull base meningioma with a minimum follow‑up of 6 months.

Results:
Between 2/ 2008 and 3/ 2012, 11 surgeries for skull base meningioma were performed. Olfactory meningioma was treated endonasally in 3 cases, sellar or parasellar meningioma in 8 cases. The goal of the surgery in 7 cases was radical resection of meningioma. Resection Simpson 1 was achieved in 6 cases (86%). Partial/ subtotal resection was planned and performed in 2 cases. Biopsy of the tumor was planned and performed in 2 cases. No postoperative neurological deficit, hypopituitarism or diabetes insipidus were observed. Preoperatively, a total of 5 patients had visual field deficit. Postoperative worsening was not observed, deficit was stable after surgery in 1 case and it improved to normal in 4 cases. Postoperative cerebrospinal leakage led to repeated surgery in 2 cases (18%). Postoperative cerebrospinal leakage did not cause any morbidity when evaluated 30 days after surgery.

Conclusions:
Endonasal endoscopic resection of the skull base meningiomas in selected cases at centres with extensive experience with endoscopic endonasal surgery represents an alternative technique to transcranial surgery. Higher risk of postoperative cerebrospinal leakage represents a disadvantage of endoscopic technique. It also needs to be considered that the patients who underwent this procedure have so far had a shorter follow‑up. Absence of any brain retraction and potentially lower risk of postoperative vision deterioration represent advantages of the endonasal technique.

Key words:
meningioma – skull base – endoscopy

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