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Updated: Jun 27, 2026
Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
Published on: July 5, 2021
Anterior Midline Skull Base Meningiomas: A Systematic Review of Resection Rates, Functional Outcomes, and
Umid Sulaimanov1, Irem Uslu1, Omar Alomari2
1Department of Neurological Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, WI 53792, USA.
Abstract:
Objectives: Anterior midline skull base meningiomas, such as olfactory groove meningiomas (OGMs), planum sphenoidale meningiomas, and tuberculum sellae meningiomas pose significant surgical challenges due to their proximity to neurovascular and olfactory structures. The widespread use of the vascularized nasoseptal flap (NSF) has expanded the role of the endoscopic endonasal approach (EEA). This systematic review compares outcomes of EEA and the transcranial approach (TCA) in the NSF era. Methods: PubMed, Embase, and Scopus were searched following PRISMA guidelines for studies published January 2010 and August 2025 comparing EEA and TCA for OGMs and tuberculum sellae/planum sphenoidale (TS/PS) meningiomas with NSF reconstruction. Thirty-five studies (1866 patients) were included and outcomes were stratified by tumor subtype. Results: Gross total resection (GTR) exceeded 90% across both approaches. EEA was associated with superior visual improvement in TS/PS meningiomas, particularly with optic canal involvement, while TCA resulted in better olfactory preservation in OGMs. Cerebrospinal fluid (CSF) leak rates have declined substantially with vascularized NSF reconstruction, especially for TS/PS meningiomas. Conclusions: Both EEA and TCA achieve high GTR rates for anterior midline skull base meningiomas. EEA provides advantages for visual outcomes in TS/PS meningiomas, whereas TCA are favored for olfactory preservation in OGMs. Approach selection should be individualized based on tumor anatomy and functional priorities.
Insights
Endoscopic endonasal approach (EEA) and transcranial approach (TCA) offer high gross total resection rates for skull base meningiomas. EEA excels in visual outcomes for specific tumors, while TCA preserves olfactory function better in others.
Area of Science:
- Neurosurgery
- Skull Base Surgery
- Endoscopic Surgery
Background:
- Anterior midline skull base meningiomas (e.g., olfactory groove meningiomas) present surgical challenges due to proximity to critical structures.
- The endoscopic endonasal approach (EEA) has advanced with techniques like the vascularized nasoseptal flap (NSF).
Purpose of the Study:
- To systematically compare the outcomes of EEA and transcranial approach (TCA) for anterior midline skull base meningiomas in the era of NSF reconstruction.
- To analyze functional outcomes, including visual and olfactory preservation, and complication rates.
Main Methods:
- Systematic review of PubMed, Embase, and Scopus databases (January 2010 - August 2025) adhering to PRISMA guidelines.
- Inclusion of 35 studies encompassing 1866 patients comparing EEA and TCA for olfactory groove meningiomas (OGMs) and tuberculum sellae/planum sphenoidale (TS/PS) meningiomas with NSF reconstruction.
- Stratification of outcomes by tumor subtype.
Main Results:
- Both EEA and TCA achieved over 90% gross total resection (GTR) rates.
- EEA demonstrated superior visual improvement for TS/PS meningiomas, especially with optic canal involvement.
- TCA showed better olfactory preservation for OGMs.
- Vascularized NSF reconstruction significantly reduced cerebrospinal fluid (CSF) leak rates, particularly for TS/PS meningiomas.
Conclusions:
- Both EEA and TCA are effective for achieving high GTR rates in anterior midline skull base meningiomas.
- EEA offers advantages in visual outcomes for TS/PS meningiomas, whereas TCA is preferred for olfactory preservation in OGMs.
- Individualized approach selection based on tumor specifics and patient priorities is crucial.
