Endoscopic Endonasal Resection of Skull Base Meningiomas

Česká verzia

Authors: D. Netuka ¹; V. Masopust ¹; T. Belšan ²; F. Kramář ¹; V. Hána ³; V. Beneš ¹
Authors place of work: Neurochirurgická klinika 1. LF UK a ÚVN – Vojenská fakultní nemocnice Praha ¹; Radiologické oddělení, ÚVN – Vojenská fakultní nemocnice Praha ²; III. interní klinika 1. LF UK a VFN v Praze ³
Published in the journal: Cesk Slov Neurol N 2013; 76/109(4): 446-452
Category: Original Paper

Podpořeno IGA MZ NT 14256.

Summary

Study aim:
Endoscopic technique enables endonasal surgery of non‑pituitary skull base lesions. Several cases of endonasal resection of the skull base meningiomas have been described.

Methods and material:
At our institution, 614 endoscopic endonasal procedures were performed untill June 2012. Intraoperative MRI was performed in 409 cases. We conducted an analysis of all endoscopic endonasal procedures for the skull base meningioma with a minimum follow‑up of 6 months.

Results:
Between 2/ 2008 and 3/ 2012, 11 surgeries for skull base meningioma were performed. Olfactory meningioma was treated endonasally in 3 cases, sellar or parasellar meningioma in 8 cases. The goal of the surgery in 7 cases was radical resection of meningioma. Resection Simpson 1 was achieved in 6 cases (86%). Partial/ subtotal resection was planned and performed in 2 cases. Biopsy of the tumor was planned and performed in 2 cases. No postoperative neurological deficit, hypopituitarism or diabetes insipidus were observed. Preoperatively, a total of 5 patients had visual field deficit. Postoperative worsening was not observed, deficit was stable after surgery in 1 case and it improved to normal in 4 cases. Postoperative cerebrospinal leakage led to repeated surgery in 2 cases (18%). Postoperative cerebrospinal leakage did not cause any morbidity when evaluated 30 days after surgery.

Conclusions:
Endonasal endoscopic resection of the skull base meningiomas in selected cases at centres with extensive experience with endoscopic endonasal surgery represents an alternative technique to transcranial surgery. Higher risk of postoperative cerebrospinal leakage represents a disadvantage of endoscopic technique. It also needs to be considered that the patients who underwent this procedure have so far had a shorter follow‑up. Absence of any brain retraction and potentially lower risk of postoperative vision deterioration represent advantages of the endonasal technique.

Key words:
meningioma – skull base – endoscopy

Zdroje

1. Nakamura M, Roser F, Struck M, Vorkapic P, Samii M.Tuberculum sellae meningiomas: clinical outcome considering different surgical approaches. Neurosurgery 2006; 59(5): 1019– 1028.

2. Nakamura M, Struck M, Roser F, Vorkapic P, Samii M.Olfactory groove meningiomas: clinical outcome and recurrence rates after tumor removal through the frontolateral and bifrontal approach. Neurosurgery 2007; 60(5): 844– 852.

3. Gardner PA, Kassam AB, Thomas A, Snyderman CH,Carrau RL, Mintz AH et al. Endoscopic endonasal resection of anterior cranial base meningiomas. Neurosurgery 2008; 63(1): 36– 52.

4. Feiz‑ Erfan I, Han PP, Spetzler RF, Horn EM, Klopfenstein JD, Porter RW et al. The radical transbasal approach for resection of anterior and midline skull base lesions. J Neurosurg 2005; 103(3): 485– 490.

5. Ganna A, Dehdashti AR, Karabatsou K, Gentili F. Fronto‑ basal interhemispheric approach for tuberculum sellae meningiomas; long‑term visual outcome. Br J Neurosurg 2009; 23(4): 422– 430.

6. Ohta K, Yasuo K, Morikawa M, Nagashima T, Tamaki N. Treatment of tuberculum sellae meningiomas: a long‑term follow‑up study. J Clin Neurosci 2001; 8 (Suppl 1): 26– 31.

7. Matoušek P, Lipina R, Paleček T, Hrbáč T, Komínek P.Endoskopická transnazální chirurgie hypofýzy – výhody spolupráce otorinolaryngologa a neurochirurga. Cesk Slov Neurol N 2010; 73/ 106(5): 542– 545.

8. Máca K, Šteffl M, Svoboda T, Vidlák M. Přímá endoskopická endonazální transsfenoidální hypofýzektomie – první zkušenosti. Sborník abstrakt: Sjezd České a Slovenské neurochirurgické společnosti Opočno 2002: 28.

9. Máca K, Vidlák M, Svoboda T, Smrčka M, Štefl M. Endoskopické operace intrasellárních lézí – naše zkušenosti. Sborník abstrakt: Kuncův memoriál Praha 2008: 13.

10. Vacek P, Hrabě V, Mraček J. Endoskopický endonasální binostrální navigovaný přístup k adenomům hypofýzy – prvních 18 měsíců zkušeností. Cesk Slov Neurol N 2009; 72/ 105 (Suppl 1): S47– S48.

11. Lipina R, Matoušek P, Paleček T, Komínek P. Rozšířený transnazální endoskopický přístup k nádorům lebeční spodiny a očnice. Cesk Slov Neurol N 2012; 75/ 108(3): 326– 332.

12. Van Gompel JJ, Frank G, Pasquini E, Zoli M, Hoover J, Lanzino G. Expanded endonasal endoscopic resection of anterior fossa meningiomas: report of 13 cases and meta‑analysis of the literature. Neurosurg Focus 2011; 30(5): E15.

13. Wang Q, Lu XJ, Li B, Ji WY, Chen KL. Extended endoscopic endonasal transsphenoidal removal of tuberculum sellae meningiomas: a preliminary report. J Clin Neurosci 2009; 16(7): 889– 893.

14. Hadad G, Bassagasteguy L, Carrau RL, Mataza JC,Kassam A, Snyderman CH et al. A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope 2006; 116(10): 1882– 1886.

15. Kassam AB, Thomas A, Carrau RL, Snyderman CH,Vescan A, Prevedello D et al. Endoscopic reconstruction of the cranial base using a pedicled nasoseptal flap. Neurosurgery 2008; 63 (1 Suppl 1): ONS44– ONS52.

16. Dusick JR, Esposito F, Kelly DF, Cohan P, DeSalles A, Becker DP et al. The extended direct endonasal transsphenoidal approach for nonadenomatous suprasellar tumors. J Neurosurg 2005; 102(5): 832– 841.

17. Fatemi N, Dusick JR, de Paiva Neto MA, Kelly DF. The endonasal microscopic approach for pituitary adenomas and other parasellar tumors: a 10‑year experience. Neurosurgery 2008; 63 (4 Suppl 2): 244– 256.

18. Fatemi N, Dusick JR, de Paiva Neto MA, Malkasian D,Kelly DF. Endonasal versus supraorbital keyhole removal of craniopharyngiomas and tuberculum sellae meningiomas. Neurosurgery 2009; 64 (5 Suppl 2): 269– 284.

19. Benjamin V, Russell SM. The microsurgical nuances of resecting tuberculum sellae meningiomas. Neurosurgery 2005; 56 (Suppl 2): 411– 417.

20. de Divitiis E, Esposito F, Cappabianca P, Cavallo LM,de Divitiis O. Tuberculum sellae meningiomas: high route or low route? A series of 51 consecutive cases. Neurosurgery 2008; 62(3): 556– 563.

21. Kitano M, Taneda M, Nakao Y. Postoperative improvement in visual function in patients with tuberculum sellae meningiomas: results of the extended transsphenoidal and transcranial approaches. J Neurosurg 2007; 107(2): 337– 346.

22. Wang Q, Lu XJ, Ji WY, Yan ZC, Xu J, Ding YS et al. Visual outcome after extended endoscopic endonasal transsphenoidal surgery for tuberculum sellae meningiomas. World Neurosurg 2010; 73(6): 694– 700.

23. Bowers CA, Altay T, Couldwell WT. Surgical decision‑ making strategies in tuberculum sellae meningioma resection. Neurosurg Focus 2011; 30(5): E1.

24. Couldwell WT, Weiss MH, Rabb C, Liu JK, Apfelbaum RI, Fukushima T. Variations on the standard transsphenoidal approach to the sellar region, with emphasis on the extended approaches and parasellar approaches: surgical experience in 105 cases. Neurosurgery 2004; 55(3): 539– 547.

25. Laufer I, Anand VK, Schwartz TH. Endoscopic, endonasal extended transsphenoidal, transplanum transtuberculum approach for resection of suprasellar lesions. J Neurosurg 2007; 106(3): 400– 406.

26. Hentschel SJ, DeMonte F. Olfactory groove meningiomas. Neurosurg Focus 2003; 14(6): e4.

27. El‑ Bahy K. Validity of the frontolateral approach as a minimally invasive corridor for olfactory groove meningiomas. Acta Neurochir (Wien) 2009; 151(10): 1197– 1205.

28. van Lindert EJ, Grotenhuis JA. The combined supraorbital keyhole‑ endoscopic endonasal transsphenoidal approach to sellar, perisellar and frontal skull base tumors: surgical technique. Minim Invasive Neurosurg 2009; 52(5– 6): 281– 286.

29. de Divitiis E, Esposito F, Cappabianca P, Cavallo LM, de Divitiis O, Esposito I. Endoscopic transnasal resection of anterior cranial fossa meningiomas. Neurosurg Focus 2008; 25(6): E8.

30. Webb‑ Myers R, Wormald PJ, Brophy B. An endoscopic endonasal technique for resection of olfactory groove meningioma. J Clin Neurosci 2008; 15(4): 451– 455.