engleski

Keyhole surgery in the Treatment of Skull Base Meningeomas

Background: Keyhole approach to the skull base pathology has gained in popularity over the last couple of years. The approach usually implies a small 2.5x1.5 craniotomy placed in the supraorbital region and a skin incision in the eyebrow. The goal of this study was to analyze the effectiveness of this particular surgical approach to the anterior skull base meningeomas on a sample of patients seen by our service in the last seven years. Methods: In the 1998-2004 period, we used this approach in the treatment of a total of 782 patients. Among them, there were 50 patients with the skull base meningeomas, of which there were 28 tuberculum selle, 14 medial sphenoid ridge, 5 olfactory groove and 3 frontal skull base meningeomas. There were 34 females and 16 males with the age distribution between 28 and 73. The preop diagnostics included CT, MR and also DSA in particular cases as well as the endocrinological and ophthalmologic assessments. The follow-up period varied between 3 months and 6 years. The preop KPS score and psychological testing were compared with the postop measurements. Results: All lesions were radically removed at Simpson grade II. The average tumor size was 3.6 cm in diameter varying between 1.3 and 6.2 cm. There were no changes between the preop and postop KPS scores (90) and no significant changes in the postop psychological assessment. There was no mortality. Postoperative complications included 2 CSF leak, 7 frontal branch and the facial nerve palsy, visual impairments in 6 cases. There were 2 recurrences, one at the follow-up of 4 and the other at 5 years. In 3 cases, radiation therapy was suggested because of the histopatological findings of meningeoma atypicum. Conclusion : Based on our results, the application of the so-called “ minimally invasive surgery” , even in large basal meningeomas, is a safe and elegant option benefiting both the patients and the surgeons. With the use of modern neurosurgical tools such as neuronavigation, ultrasound aspiration and endoscopic control, in the majority of cases, surgery of the anterior skull base meningeomas does not require large exposures of bone and nervous structures.

key hole; skull base meningeoma; minimally invasive neurosurgery

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