The extended, transnasal, transsphenoidal approach for anterior skull base meningioma: considerations in patient selection

摘要: In this study, we set out to define our institutional criteria for patient eligibility transsphenoidal resection of parasellar meningiomas, and report experience with extended transnasal approaches these lesions. We aimed discuss the important considerations selection risk stratification optimize outcomes patients difficult lesions, also include that should be reviewed during surgical approach selection. Medical records from Brigham Women’s Hospital were retrospectively all who underwent surgery pituitary disease senior author April 2008 March 2017 (938 procedures). Patients undergoing anterior skull base meningioma identified data collected. Seven (four women, three men) (five endoscopic, one microscopic, hybrid endoscopic/microscopic) pathologically-confirmed meningiomas study period. Five presented visual field deficits, headache, two hypopituitarism, woman infertility. The median maximum tumor diameter was 1.7 cm (range 1.4–4.2 cm). Six subtotal resection, gross total resection. MIB-1 index 2.3 1.0–7.6). Complications included readmissions (one on POD11 small bowel obstruction, POD48 epistaxis), development new onset thyroid deficiency transient diabetes insipidus in patient. Two had reoperations by craniotomy recurrence after 5 6 years, respectively. Although more commonly treated transcranially, are sometimes amenable transphenoidally. Patient is critical, multiple factors, including size, consistency, location, surgeon preference, presenting symptoms each affect optimum approach. have developed so can used resect or debulk safely favorable outcomes.