Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA -
Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
J Neurosurg Sci. 2021 Apr;65(2):118-132. doi: 10.23736/S0390-5616.20.05085-7. Epub 2020 Nov 27.
Meningiomas along the anterior skull base arise from the midline but have historically been resected via open cranial approaches with lateral to medial trajectories. The endoscopic endonasal approach (EEA) offers a direct, inferomedial approach which has demonstrated several superior qualities for their resection. These meningiomas include tuberculum sellae, planum sphenoidale, and olfactory groove meningiomas. While early gross total resection (GTR) was lower than open approaches, EEA has currently achieved comparable rates of GTR and significantly improved postoperative visual outcomes. Rate of cerebrospinal fluid (CSF) leak was one of the early complicating features preventing widespread use of EEA. However, CSF leak rates have dramatically fallen into a tolerable range with introduction of the vascularized nasoseptal flap. Olfactory groove meningiomas often present with anosmia which is persistent after endonasal approach. Rates of other complications have proven similar between EEA and open approaches and include: vascular injury, infection, morbidity, and mortality. With the appropriate team and experience, EEA for anterior skull base meningiomas is increasingly becoming the standard for resection of these lesions. However, there are certain anatomic considerations, patient features, and other aspects which may favor the open approach over EEA, and vice versa; these must be carefully and judiciously evaluated preoperatively. Overall, resection and recurrence rates are comparable, complication rates fall within a very acceptable range, and patients experience superior cosmesis and improved visual outcome with this approach.
沿着颅前底生长的脑膜瘤起源于中线，但历史上一直通过外侧至内侧的颅切开术进行切除。内镜经鼻入路（EEA）提供了一种直接的、中下的入路，已经证明对其切除具有多种优越的特性。这些脑膜瘤包括鞍结节、蝶骨平台和嗅沟脑膜瘤。虽然早期的大体全切除（GTR）低于开放方法，但 EEA 目前已经达到了可比的 GTR 率，并显著改善了术后视觉结果。脑脊液（CSF）漏的发生率是早期限制 EEA 广泛应用的并发症之一。然而，随着带血管鼻中隔瓣的引入，CSF 漏的发生率已显著降至可接受的范围。嗅沟脑膜瘤常伴有嗅觉丧失，经鼻入路后仍持续存在。其他并发症的发生率在 EEA 和开放方法之间证明是相似的，包括：血管损伤、感染、发病率和死亡率。在具备适当的团队和经验的情况下，对于颅前底脑膜瘤的 EEA 越来越成为这些病变切除的标准。然而，某些解剖学考虑因素、患者特征和其他方面可能使开放方法优于 EEA，反之亦然；这些必须在术前仔细和明智地评估。总体而言，切除和复发率相当，并发症发生率处于非常可接受的范围内，患者采用这种方法可获得更好的美容效果和改善的视觉结果。
