Endoscopic Endonasal versus Conventional MicroscopicTranscranial Approach in Management of Patients with Supra-Sellar Meningiomas
Mohamed Ashraf Ghobashy, Ahmed Elsayed Desouky, Abdel Rahman Hesham Elgayar, Ashraf Mohamed Arakeep- General Medicine
Background
Meningiomas located at the anterior skull base are amenable to surgical resection. tuberculum sellae meningioma (TSM) originate in the sellar region, and similarly, account for approximately 5–10% of all intracranial meningioma. Although slow-growing, these tumors through mass effect upon, the optic nerve, pituitary gland and carotid arteries, can present symptomatically. The intention of surgery is to alleviate these symptoms without incurring neurological deficit.
Objective
To review and summarize available knowledge on the comparison between Endoscopic Endonasal versus conventional Microscopic Transcranial approach in Management of patients with supra-sellar Meningiomas with regard to clinical outcome and extent of tumor excision and complications.
Materials and Methods
This Systematic review/Meta-analysis included 10 studies from 2007 to 2019, all were retrospective studies summarize available knowledge on the comparison between Endoscopic Endo-nasal versus conventional Microscopic Trans-cranial approach in Management of patients with supra-sellar Meningiomas with regard to clinical outcome and extent of tumor excision and complications.
Data Sources
Medline databases (PubMed, Medscape, ScienceDirect. EMF-Portal).
Results
Gross total resection (mean, 95% CI: 1.12,2.66) Z = 2.47, (p0.01). Visual improvement (mean, 95% CI: 1.72,7.33) Z = 3.42, (p0.0006). CSF leakage (mean, 95% CI: 1.87,10.39) Z = 3.39, (p0.0007) Near total resection (mean, 95% CI: 0.28,1.0) Z = 1.95, (p0.05). Overall Complications (mean, 95% CI: 0.80,4.58) Z = 1.45, (p0.15). Recurrence (mean, 95% CI: 0.64,2.71) Z = 0.78, (p0.45). Mortality (mean, 95% CI: 0.34,5.78) Z = 0.46, (p0.64).
Conclusion
Supra Sellar Meningiomas is amenable to surgical resection. This can be performed by the traditional Trans-cranial Approach, or the Endoscopic Endo-nasal Approach with largely comparable operative outcomes. However, this meta-analysis demonstrated through direct comparative studies, that differences in postoperative complications do exist, where the Endoscopic Endo-nasal Approach is associated with lower likelihood of worse vision, and higher CSF leak, the Endoscopic Endo-nasal Approach was significantly better than trans-cranial approach as regard gross total resection. There was insignificant differences between two procedure in recurrence and mortality. Neurosurgeons caring for patients with these supra-sellar meningiomas should be prepared to offer an appropriate approach based on current available evidence involving the specific meningioma type.