Endoscopic endonasal resection of anterior skull base meningiomas and mucosa: Implications for resection, reconstruction, and recurrence

John Y.K. Lee, Julieta E. Barroeta, Jason G. Newman, Alexander G. Chiu, Sriram Venneti, M. Sean Grady

Research output: Contribution to journalArticle

6 Scopus citations

Abstract

Background Meningiomas of the anterior skull base are attractive tumors for resection via an endoscopic endonasal route. The use of the vascularized Hadad-Bassagasteguy nasoseptal flap has dramatically reduced the cerebrospinal fluid (CSF) leak rate-the veritable Achilles heel of this surgical approach. Benign meningiomas, however, can erode through the nasal mucosa-the very same mucosa that is used to reconstruct the anterior cranial fossa floor. The goal of this study was to describe the presence of meningioma invasion into the mucosa in patients who underwent endoscopic endonasal resection of ventral skull base meningiomas. The implications of this finding are discussed with respect to resection, reconstruction, and recurrence. Patients, Materials, and Methods This is a retrospective review of three patients who underwent endoscopic endonasal complete resection of ventral skull base meningiomas. Surgically excised tissues were processed for routine histopathological analysis. Results A complete resection of the bone, dura, and tumor was performed in all three cases. Both patients with visual deficits improved. The first patient to undergo endoscopic surgical resection developed a CSF leak, but the later two patients with larger tumors did not. Histopathological analysis demonstrated mucosal invasion by World Health Organization (WHO) grade I meningioma in two of the three cases. Conclusion Ventral anterior skull base meningiomas can invade through bone into the mucosa. Because the endoscopic endonasal resection of these meningiomas often requires the use of a vascularized nasoseptal flap to minimize CSF leak complications, it is possible that the nasoseptal flap itself may be compromised by tumor tissue. The creation of the nasoseptal flap should take the findings of this study into consideration to minimize late recurrence.

Original languageEnglish (US)
Pages (from-to)12-17
Number of pages6
JournalJournal of Neurological Surgery, Part A: Central European Neurosurgery
Volume74
Issue number1
DOIs
StatePublished - Jan 1 2013
Externally publishedYes

Keywords

  • Endoscopic
  • Meningiomas
  • Mucosa
  • Nasoseptal flap
  • Skull base

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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