Exploring efficacy: A comprehensive review of extended transsphenoidal approach in anterior skull base meningiomas

Anterior skull base meningiomas can cause significant symptoms such as mass effect and neuropsychological decline, necessitating surgical resection. The endoscopic extended transnasal approach has emerged as a minimally invasive alternative to craniotomy, offering a means to address these tumors despite challenges due to the proximity of critical neurovascular structures and the high risk of complications such as cerebrospinal fluid (CSF) leaks. This systematic review and meta-analysis evaluate the safety and efficacy of extended transsphenoidal techniques in anterior skull base meningiomas.

This study followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the Cochrane Handbook. A search was performed in Medline, Embase, Cochrane, and Ovid. Eligible studies included those (1) in English, (2) with patients having anterior skull base meningiomas, and (3) who underwent endoscopic surgical management. Endpoints included CSF leak, length of stay, complications, and mortality.

The analysis included data from 23 studies involving 573 patients with a median age of 54.77 (range 39.5-67.3) years. Approximately 71% of participants were female. The mean length of stay was 7.50 days (95% confidence interval [CI]: 6.64-8.47). The overall complication rate was 35% (95% CI: 0.22-0.49), with minor complications also occurring in 6% of cases (95% CI: 0.02-0.10). Major complications were reported in 20% of cases (95% CI: 0.10-0.30). The CSF leak rate was 7% (95% CI: 0.04-0.10).

In the setting of complex anatomical challenges and inherent risks, the technique showed a moderate complication rate and length of hospital stay. This method demonstrated lower CSF leak and complication rates compared to previously published studies from the past decade.