Anterior basal meningiomas: Can different approaches make a difference?

Anterior basal meningioma extends from the crista galli to the tuberculum sellae. They can be surgically approached through pterional, anterior bi-frontal trans-basal, eyebrow, trans-nasal, and notably through the fronto-lateral approach (FLA). Here, we highlight the feasibility and efficacy of this approach.

A prospective observational study was conducted on 45 patients with anterior basal meningiomas using fronto-lateral, pterional, eyebrow, and bifrontal trans-basal approaches. Key surgical parameters assessed included brain retraction, cisternal opening, cerebrospinal fluid (CSF) aspiration, optic canal de-roofing, nerve decompression, duration, blood loss, bony work, and postoperative complications such as CSF leakage, muscle atrophy, and nerve palsy.

The patients were followed for an average of 2.8 years. Olfactory groove meningiomas accounted for 35.5% and tuberculum sellae for 46.6%, with headache and visual loss being common symptoms. Gross total resection was achieved in 95% of cases. The FLA was associated with the shortest operative time (P = 0.00001), high surgical unilaterality, minimal retraction, early CSF aspiration, less blood loss, reduced bony work, and better nerve preservation.

The fronto-lateral (lateral supra-orbital) approach is the most in line with the principles of simplicity and safety. The use of papaverinated saline combined with early optic canal de-roofing has been associated with significant visual improvement in cases presenting with visual deterioration.