Expanded endoscopic endonasal approaches to skull base meningiomas

Area of Science:

• Neurosurgery
• Skull Base Surgery
• Endoscopic Surgery

Background:

• Anterior cranial base meningiomas traditionally required open craniotomies (frontal/frontolateral).
• These approaches often involve significant brain retraction and manipulation of neural structures.
• Advances in endoscopic techniques have enabled minimally invasive access to complex skull base regions.

Purpose of the Study:

• To describe the techniques for resecting anterior cranial base meningiomas using the expanded endoscopic endonasal approach (EEEA).
• To highlight the advantages of EEEA in minimizing brain retraction and edema.
• To present selected cases treated with EEEA.

Main Methods:

• Utilized the expanded endoscopic endonasal approach (EEEA).
• Performed transclival, transphenoidal, transplanum, and transcribiform resections.
• Applied techniques developed for pituitary lesion treatment to anterior skull base meningiomas.

Main Results:

• EEEA allows access to a wider range of anterior skull base locations including petrous ridge, anterior clinoid, clivus, sella, parasellar region, tuberculum, planum, olfactory groove, and crista galli.
• The approach minimizes brain retraction, reducing associated edema and neural manipulation.
• Successful resection of anterior cranial base meningiomas was achieved in selected cases using these endoscopic techniques.

Conclusions:

• The expanded endoscopic endonasal approach (EEEA) is a viable and advantageous technique for treating anterior cranial base meningiomas.
• EEEA offers a less invasive alternative to traditional open approaches, preserving neural structures and reducing postoperative morbidity.
• This technique expands the armamentarium for skull base surgeons, enabling resection of tumors in challenging locations through a natural orifice.