Endoscopic Endonasal Approaches for Anterior Skull Base Meningiomas

Abstract

Anterior skull base meningiomas are a diverse group of tumors that involve different locations. The role of the expanded endoscopic transnasal approach in the management of anterior cranial fossa meningiomas has significantly changed over the past 2 decades. Patient selection is paramount to benefit from the advantages of endoscopic transnasal surgery such as direct access to ventral skull base lesions avoiding brain and brainstem retraction, early de-vascularization, removal of bone infiltrated by tumor, near-field magnification, better surgical field illumination, and minimal manipulation of neurovascular structures. Here we discuss some of the main limitations and advantages of the endoscopic transnasal approach related to patient selection, including nuances of their management, discussing preoperative imaging and planning, the surgical approach, and future perspectives in the treatment of these tumors.