Anterior basal meningiomas: Can different approaches make a difference?

Area of Science:

• Neurosurgery
• Surgical Oncology

Background:

• Anterior basal meningiomas originate from the crista galli to the tuberculum sellae.
• Surgical access includes pterional, bifrontal trans-basal, eyebrow, trans-nasal, and fronto-lateral approaches (FLA).

Purpose of the Study:

• To evaluate the feasibility and efficacy of the fronto-lateral approach (FLA) for anterior basal meningiomas.
• To compare FLA with other surgical approaches regarding key surgical parameters and outcomes.

Main Methods:

• A prospective observational study of 45 patients with anterior basal meningiomas.
• Utilized fronto-lateral, pterional, eyebrow, and bifrontal trans-basal approaches.
• Assessed parameters: brain retraction, cisternal opening, CSF aspiration, optic canal de-roofing, nerve decompression, duration, blood loss, bony work, and complications.

Main Results:

• Gross total resection achieved in 95% of cases.
• FLA demonstrated the shortest operative time (P = 0.00001), minimal retraction, and less blood loss.
• FLA was associated with better nerve preservation and reduced bony work.

Conclusions:

• The fronto-lateral approach aligns with simplicity and safety principles for anterior basal meningiomas.
• Early optic canal de-roofing and papaverinated saline use correlate with significant visual improvement.