Extensive Surgical Exposures for Enormous Skull Base Meningiomas: A Single Institutional Experience

Abstract

Background: Huge, sizeable, anterior skull base meningioms are relatively common in tertiary care hospitals. Here, a single institutional experience dealing with such lesions is presented.
Material and Methods: A retrospective review of 30 consecutive patients was done, who were treated for a variety of anterior skull base meningioms at Department of Neurosurgery, Lahore General Hospital, Lahore. Management and outcome were noted and analyzed.
Results: In this study, thirty skull lesions were identified in 21 female (70%) and 9 male (30%) patients, with a mean age at diagnosis was 39.7 years. These benign lesions commonly presented with headache (n = 19), visual deterioration (n = 9) & seizures (n = 5). Olfactory groove (n = 15) was the most frequent site encountered in this study followed by planum (n = 5), tuberculum sallae (n = 4) and clinoidal area (n = 2). Gross total resection achieved in all patients by fronto-orbital craniotomy (n = 15), while frontal craniotomy alone or with temporal extension performed in other patients (n = 13 + 2). Complications observed more in frontal craniotomy patients, than fronto-orbital craniotomy patients.
Conclusions: Majority of the extensive anterior skull meningiomas can be addressed by enormous fronal exposure including supraorbital rim to reduce the intraoperative brain retraction, with wide surgical exposure & great surgical freedom for gross total excision with ease. Recurrence is uncommon after gross total resection.