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. 2020 Nov 3;12(11):3243.
doi: 10.3390/cancers12113243.

Midline Meningiomas of the Anterior Skull Base: Surgical Outcomes and a Decision-Making Algorithm for Classic Skull Base Approaches

Amir Kaywan Aftahy  1 , Melanie Barz  1 , Philipp Krauss  1 , Arthur Wagner  1 , Nicole Lange  1 , Alaa Hijazi  1 , Benedikt Wiestler  2 , Bernhard Meyer  1 , Chiara Negwer  1 , Jens Gempt  1
Affiliations

Midline Meningiomas of the Anterior Skull Base: Surgical Outcomes and a Decision-Making Algorithm for Classic Skull Base Approaches

Amir Kaywan Aftahy et al. Cancers (Basel). .

Abstract

(1) Background: Midline meningiomas such as olfactory groove (OGMs), planum sphenoidale (PSMs), or tuberculum sellae meningiomas (TSMs) are challenging, and determining the appropriate approach is important. We propose a decision algorithm for choosing suitable transcranial approaches. (2) Methods: A retrospective chart review between 06/2007 and 01/2020. Clinical outcomes, radiographic findings, and postoperative complication rates were analyzed with respect to operative approaches. (3) Results: We included 88 patients in the analysis. Of these, 18.2% (16/88) underwent an interhemispheric approach, 72.7% (64/88) underwent a pterional/frontolateral/supraorbital approach, 2.3% (2/88) underwent a unilateral subfrontal approach, and 6.8% (6/88) underwent a bifrontal approach. All OGMs underwent median approaches, along with one PSM. All of the other PSMs and TSMs were resected via lateral approaches. The preoperative tumor volume was ∅20.2 ± 27.1 cm3. Median approaches had significantly higher tumor volume but also higher rates of Simpson I resection (75.0% vs. 34.4%). An improvement of visual deficits was observed in 34.1% (30/88). The adverse event rate was 17.0%. Median follow-up was 15.5 months (range 0-112 months). (4) Conclusions: Median approaches provides satisfying results for OGMs, lateral approaches enable sufficient exposure of the visual apparatus for PSMs and TSMs. In proposing a simple decision-making algorithm, the authors found that satisfactory outcomes can be achieved for midline meningiomas.

Keywords: anterior skull base; neurosurgical oncology; olfactory groove meningioma; operative technique; planum sphenoidale meningioma; transcranial approaches; tuberculum sellae meningioma.

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Conflict of interest statement

Jens Gempt and Bernhard Meyer (BM) work as consultants for Brainlab (Brainlab AG, Feldkirchen). In addition, BM works as a consultant for Medtronic, Spineart, Icotec, Relievant and Depuy/Synthes, as a member of their advisory boards. Furthermore, BM reports financial relationships with Medtronic, Ulrich Medical, Brainlab, Spineart, Icotec, Relievant and Depuy/Synthes. He received personal fees and research grants for clinical studies from Medtronic, Ulrich Medical, Brainlab, Icotec and Relievant. All of this happened independently of the submitted work. BM receives royalties and holds the patent for Spineart. All of the named potential conflicts of interest are unrelated to this study. There are no further conflicts of interest regarding the authors.

Figures

Figure 1
Figure 1
Illustration of performed approaches, angle of exposure, and approach-related complications, dichotomized into median (MA) and lateral (LA) approaches.
Figure 2
Figure 2
Proposed decision-making algorithm for targeting olfactory groove (OGM), planum sphenoidale (PSM) or tuberculum sellae meningiomas (TSM) based on our surgical experience, findings and statistical analysis. (MA = median approach; LA = lateral approach).
Figure 3
Figure 3
Exemplary case of a TSM with visual affection.
Figure 4
Figure 4
Exemplary case of a huge OGM.
Figure 5
Figure 5
Exemplary case of a calcified PSM.
See this image and copyright information in PMC

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