Endoscopic Endonasal and Keyhole Surgery for the Management of Skull Base Meningiomas

The resection of anterior skull base meningiomas has traditionally been performed via pterional or unilateral/bilateral subfrontal craniotomies. The supraorbital keyhole approach and the endoscopic endonasal approach, techniques in which the endoscope is used to aid visualization, were developed to provide alternative, less-invasive approaches to aid the resection of these tumors. The individual characteristics of each tumor, such as location and size, are the main determinants guiding the choice of approach. In this article, the advantages and disadvantages of each approach are discussed, along with complications specific to each technique. Furthermore, a detailed procedural description of each surgical approach is described.