Abstract
Objective:
The current management paradigm for skull base meningiomas includes cytoreductive surgery and gross total resection when possible, followed by adjuvant radiotherapy if necessary. Various surgical approaches have been employed for resection of these lesions. Traditionally, these have utilized extensive bone drilling, brain retraction, and manipulation of cranial nerves. The endoscopic endonasal approach to the tuberculum sellae, planum sphenoidale, and olfactory groove represents a minimal access, maximally aggressive alternative providing a direct route to the tumor that may be preferable in a subgroup of patients.
Methods:
We performed a MEDLINE search (from years 1950-2010) to identify relevant studies. Comparisons were made between open and endoscopic series for patient and tumor characteristics as well as extent of resection, postoperative morbidity, mortality, visual outcome, and recurrence. Statistical analyses of categorical variables were undertaken using chi-square and Fisher's exact tests.
Results:
Eighty-three studies, involving 1,891 patients, were included in our review. For olfactory groove meningiomas, the open surgery cohort achieved a higher rate of gross total resection (
P
< 0.001) and lower postoperative CSF leak rate (
P
< 0.001), while the endoscopic cohort experienced more favorable visual outcomes (
P
= 0.004). For tuberculum sellae and planum meningiomas, there was no significant difference in the rate of gross total resection between groups. The open cohort had a lower postoperative CSF leak rate (
P
< 0.001), while the endoscopic cohort experienced more favorable visual outcomes (
P
= 0.015).
Conclusion:
Our systematic meta-analysis supports the conclusion that the endonasal endoscopic approach is a safe and effective alternative to traditional open cranial base surgery for the treatment of certain skull base meningiomas, particularly small midline tumors of the planum sphenoidale and tuberculum sella. At this time, olfactory groove meningiomas may have a better outcome with open surgery, depending on the experience of the group and the size and location of the tumor. Visual outcome appears to be better with the endonasal approach, indicating value in a ventral approach in minimizing manipulation of the optic apparatus. Further prospective investigations are needed to more definitively address the efficacy of endoscopic skull base meningioma resection.