Interdisciplinary Neurosurgery (Mar 2023)
Endoscopic endonasal surgery for resection of anterior skull base meningiomas: A single-center prospective study in Vietnam
Abstract
Objective: Endoscopic endonasal surgery (EES) is increasingly being applied for resection of anterior skull base meningiomas around the world. However, the role of EES in the treatment of these tumors is still controversial in low-middle income countries including Vietnam. This prospective study aims to investigate the effectiveness of EES for meningiomas located in the anterior skull base region and identify the factors that may influence surgical outcomes. Methods: From January 2017 to October 2021, 26 patients with anterior skull base meningiomas who met the inclusion criteria were enrolled. Tumors were classified based on the primary dural attachment site. Surgical outcomes were evaluated with neurological examination, formal visual tests, and magnetic resonance imaging with contrast at 3-month, 6-month, 12-month follow-up, then at subsequent doubling intervals. Results: The most common tumor location was the tuberculum sellae (50 %), followed by planum sphenoidale (31 %) and olfactory groove (19 %). Headache and visual impairment were the most common complaints, accounting for 69 % and 65 % of cases, respectively. Gross total resection (GTR) was achieved in 23 cases (88 %). Tumor size and encasement of surrounding vessels were identified as significant factors affecting the GTR rate. Visual improvement was observed in 82 % of patients who had preoperative visual impairment. One patient (3.8 %) experienced visual deterioration after surgery that did not recover after 18 months of follow-up. Postoperative cerebrospinal fluid (CSF) leak and meningitis occurred in 3/26 cases (11.5 %). In which, one patient (3.8 %) with a medical history of diabetes and hypertension developed refractory meningitis resulting in death. Conclusion: EES represents a relatively safe and effective method that might be considered as a valuable alternative to traditional open craniotomy for resection of anterior skull base meningiomas in carefully selected patients. However, postoperative CSF leak and meningitis are still limitations of this approach.
