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2015 ; 55
(9
): 735-43
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gab.com Text
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Current Status of Endoscopic Endonasal Surgery for Skull Base Meningiomas: Review
of the Literature
#MMPMID26345667
Shin M
; Kondo K
; Saito N
Neurol Med Chir (Tokyo)
2015[]; 55
(9
): 735-43
PMID26345667
show ga
Endoscopic endonasal approach (EEA) is expected to be ideal for the paramedian
ventral skull base meningiomas, allowing wide access to the ventral skull base
regions and realizing early devascularization of the tumor without retraction of
the brain. We searched clinical reports of EEA for skull base meningiomas,
written in English language, published before October 2014, using the PubMed
literature search on the website. Skull base meningiomas are subdivided by the
site of occurrence, olfactory groove (8 articles including 80 cases), tuberculum
sellae (14 articles, 153 cases), cavernous sinus (2 articles, 8 cases),
petroclival region (4 articles, 10 cases), and craniofacial region (2 articles, 5
cases), and the surgical outcomes of EEA were analyzed. In anterior skull base
regions, EEA contributed to effective improvement of the symptoms in small and
round-shaped meningiomas, but 25% of the patients had postoperative cerebrospinal
fluid rhinorrhea. In cavernous sinus and petroclival regions, successful surgical
removal largely depended on tumor consistency, and the extent of the surgical
resection proportionally increased the risks of serious complications. Thus,
judicious endoscopic resection with adjuvant radiotherapy or radiosurgery remains
to be the most reasonable treatment option. To decrease the risks of surgical
complications, the surgeons must master the closure techniques of dural defect
and meticulous microsurgical procedure under endoscopic vision. Further progress
will depend on the progresses of surgical technique in neurosurgeons engaging
this potentially "minimally invasive" surgery.