Recent advances in endonasal endoscopic resection of anterior skull base meningiomas

Abstract

The endoscope, after Gerard Guiot’s first attempt to explore the sellar cavity following the lesion removal and, then, after the endonasal experience of the ENT surgeons in Functional Endoscopic Sinus Surgery (FESS), has gained a stable position in transsphenoidal surgery, due to its vision inside the anatomy that offers wider view of the target area and permits to perform less invasive approaches. (Cappabianca P. et al., 2008) The visual and endocrine morbidity of endonasal endoscopic approach for skull base meningiomas has compared favorably with transcranial approaches, and Amin B. Kassam believes that this approach currently provides the most direct and least invasive neuroprotective strategy for many skull base meningiomas. (Kassam A.B., 2009) Raper et al. has conducted a literative review that involved 75 series and 1847 patients operated upon between the years 1950 and 2010. For olfactory-groove meningiomas, there were 568 patients in the open group and 19 patients in the endoscopic group. There was a significantly greater rate of GTR in the open group (92.9% vs 63.2%, P < 0.001) and a significantly greater rate of partial resection in the endoscopic group (0.4% vs 26.3%, P < 0.001; Graph 1). (Raper D.M. et al., 2011)