Related Experiment Video
Updated: May 27, 2026
Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
Published on: July 5, 2021
Endoscopic endonasal versus open transcranial resection of anterior midline skull base meningiomas
Ricardo J Komotar1, Robert M Starke, Daniel M S Raper
1Department of Neurological Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
Objective:
To assess the advantages and limitations of the endoscopic endonasal approach to anterior skull base meningiomas, a minimally invasive approach that avoids extensive bone drilling, brain retraction, and manipulation of nerves and critical vessels, versus open transcranial surgery.
Methods:
A MEDLINE (2000-2010) search was performed to identify series for either olfactory groove meningiomas or tuberculum sellae (TS) or planum sphenoidale meningiomas. Statistical analyses of categorical variables such as extent of resection, morbidity, and visual outcome were performed using χ(2) and Fisher exact tests.
Results:
The literature review included 60 studies, involving 1426 patients. Open surgery achieved a higher rate of gross total resection (GTR) for both olfactory groove (P < 0.001) and TS and planum (P < 0.001) meningiomas. Postoperative cerebrospinal fluid (CSF) leak occurred more frequently in the endoscopic cohort (P < 0.001). Other postoperative complications occurred more frequently in the open cohort, although this difference was not statistically significant. There were no significant differences in postoperative visual outcome between the groups.
Conclusions:
Based on the current literature, open transcranial approaches for olfactory groove and TS and planum sphenoidale meningiomas still result in higher rates of total resection with lower postoperative CSF leak rates. The endoscopic endonasal approach may be safe and effective for certain skull base meningiomas; careful patient selection and multilayer closure techniques are essential.
Insights
Open transcranial surgery offers higher gross total resection rates for anterior skull base meningiomas compared to endoscopic approaches. However, the endoscopic endonasal approach may be suitable for select cases with careful technique.
Area of Science:
- Neurosurgery
- Skull Base Surgery
- Minimally Invasive Surgery
Background:
- Anterior skull base meningiomas pose surgical challenges.
- Endoscopic endonasal approach (EEA) offers a minimally invasive alternative to open transcranial surgery.
- Comparing EEA and open approaches is crucial for optimizing patient outcomes.
Purpose of the Study:
- To evaluate the advantages and limitations of the endoscopic endonasal approach versus open transcranial surgery for anterior skull base meningiomas.
- To compare resection rates, morbidity, and visual outcomes between the two surgical techniques.
Main Methods:
- A systematic literature review of MEDLINE (2000-2010) was conducted.
- Included studies focused on olfactory groove, tuberculum sellae (TS), or planum sphenoidale meningiomas.
- Statistical analysis of categorical variables (resection extent, morbidity, visual outcome) was performed.
Main Results:
- 60 studies with 1426 patients were reviewed.
- Open surgery demonstrated higher gross total resection (GTR) rates for olfactory groove and TS/planum meningiomas (P < 0.001).
- Endoscopic approach had higher rates of postoperative cerebrospinal fluid (CSF) leak (P < 0.001); other complications were similar or more frequent in open surgery. Visual outcomes were comparable.
Conclusions:
- Open transcranial approaches currently provide higher GTR rates and lower CSF leak rates for these meningiomas.
- The endoscopic endonasal approach can be safe and effective for select anterior skull base meningiomas.
- Careful patient selection and advanced closure techniques are vital for successful endoscopic surgery.
