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Surgical management of midline anterior skull base meningiomas: experience of 30 cases
Mohamed I Refaat1, Ehab M Eissa, Mohamed H Ali
1Cairo University Hospitals, Department of Neurosurgery, El Manial, Cairo, Egypt.
Aim:
Midline anterior skull base meningiomas include olfactory groove meningiomas (OGMs), Tuberculum Sellae meningiomas (TSMs), and planum sphenoidale meningiomas (PSMs). The main surgical challenge in treating these lesions is to excise the tumor totally without causing mortality or morbidity. Studying the clinical patterns and the surgical outcomes of these lesions.
Material And Methods:
Thirty cases of midline anterior skull base lesions were included in our study. Patients were operated upon by four routes: (i) unilateral subfrontal, (ii) bilateral subfrontal, (iii) frontotemporal approach, and (iv) bifrontal basal interhemispheric. Extent of resection was classified according to the Simpson grading system. The functional outcome of the patients was assessed by comparing the preoperative and the postoperative neurological examination, as well as the Karnofsky performance scale.
Results:
We had 14 OGMs (46.7%), 9 TSMs (30%), and 7 PSMs (23.3%). The most commonly utilized approach was the subfrontal approach (unilateral or bilateral) in 80% of the cases, followed by the pterional approach in 16.6% of the cases. Total removal was achieved in 86.7% of the cases; subtotal excision was achieved in 13.3% of the cases. 41.2% of our cases showed postoperative clinical improvement. We had two mortalities in our study, representing 6.7%. We did not detect any tumor recurrences in our follow up. The median preoperative Karnofsky scale was 85, while the median postoperative Karnofsky scale was 90.
Conclusion:
Midline anterior skull base lesions are becoming amenable for total surgical excision with minimal morbidities and mortalities. Most preferred surgical routes are the subfrontal and the pterional approaches.
Insights
Surgical outcomes for midline anterior skull base meningiomas show total excision is achievable with subfrontal and pterional approaches, leading to improved patient function and low mortality.
Area of Science:
- Neurosurgery
- Oncology
- Skull Base Surgery
Background:
- Midline anterior skull base meningiomas, including olfactory groove meningiomas (OGMs), Tuberculum Sellae meningiomas (TSMs), and planum sphenoidale meningiomas (PSMs), present significant surgical challenges.
- Complete tumor excision without causing mortality or morbidity is the primary goal in treating these lesions.
Purpose of the Study:
- To investigate the clinical patterns and surgical outcomes of midline anterior skull base meningiomas.
- To evaluate the efficacy and safety of different surgical approaches for these tumors.
Main Methods:
- A retrospective study of 30 patients with midline anterior skull base lesions.
- Surgical interventions were performed via unilateral subfrontal, bilateral subfrontal, frontotemporal, or bifrontal basal interhemispheric approaches.
- Tumor resection extent was graded using the Simpson grading system, and functional outcomes were assessed using neurological examination and the Karnofsky performance scale.
Main Results:
- Olfactory groove meningiomas (OGMs) were most common (46.7%), followed by Tuberculum Sellae meningiomas (TSMs) (30%) and planum sphenoidale meningiomas (PSMs) (23.3%).
- Subfrontal approaches (unilateral or bilateral) were most frequently used (80%), achieving total tumor removal in 86.7% of cases.
- Postoperative clinical improvement was observed in 41.2% of patients, with a mortality rate of 6.7% and no tumor recurrences during follow-up. Median Karnofsky scale improved from 85 to 90.
Conclusions:
- Midline anterior skull base meningiomas can be surgically excised with minimal morbidity and mortality.
- Subfrontal and pterional approaches are the preferred surgical routes for achieving optimal outcomes in these complex tumors.
