2025 Proffered Presentations
S195: EFFECTIVENESS OF THE EXTENDED TRANSSPHENOIDAL APPROACH FOR ANTERIOR SKULL BASE MENINGIOMAS: A SYSTEMATIC REVIEW AND META-ANALYSIS
Lucca B Palavani1; Lucas Mitre2; Bernardo Nogueira3; Fabiana Honorato4; Márcio Yuri Ferreira Ferreira5; Carlos Alexandre6; Paulo Victor Ribeiro7; Isabela Banderali1; Leonardo de Barros Oliveira8; Fernando Gomes9; Gisele Lúcia Canto Gomes10; Raphael Bertani11; José Alberto Landeiro, MD, PhD12; 1Max Planck University Center; 2Faculty of Medicine, Santa Casa de São Paulo School of Medical Sciences, São Paulo, Brazil; 3Serra dos Órgãos University Center, Teresópolis - Rio de Janeiro, Brazil; 4Faculty of Medicine, Universidade Nove de Julho, Bauru - São Paulo, Brazil; 5Lenox Hill, New York, United States; 6Faculty of Medicine, University Ninth of July, São Paulo, Brazil; 7Department of Medical Genetics, University of São Paulo, São Paulo, Ribeirão Preto, Brazil; 8Department of Neurosurgery, State University of Ponta Grossa, Ponta Grossa, Paraná, Brazil; 9Faculty of Medicine, Federal University of Minas Gerais, Belo Horizonte, MG, Brazil; 10Faculty of Medicine, Federal University of Amazonas, Manaus, Amazonas; 11University of São Paulo, Department of Neurosurgery, São Paulo, SP, Brazil; 12Department of Neurosurgery, Federal Fluminense University, Rio de Janeiro, RJ, Brazil
Purpose: Anterior skull base meningiomas can lead to significant symptoms, including mass effect and neuropsychological decline, necessitating surgical resection. The endoscopic extended transnasal approach has emerged as a minimally invasive alternative to craniotomy, offering a means to address these tumors despite challenges posed by the proximity of critical neurovascular structures and the risk of complications such as CSF leaks. This systematic review and meta-analysis evaluate the safety and efficacy of extended transsphenoidal techniques in anterior skull base meningiomas.
Methods: Following PRISMA guidelines and the Cochrane Handbook, a search was conducted in Medline, Embase, Cochrane, and Ovid. Eligible studies included those in English, with patients having anterior skull base meningiomas, and who underwent endoscopic surgical management. Endpoints included CSF leak, length of stay, complications, and mortality. Major complications were permanent, while minor complications were transient. Tumor-related mortality encompassed any mortality due to tumor presentation, procedure, subsequent treatment, and postoperative course.
Results: The analysis included data from 28 studies with a total of 725 patients, having a median age of 54.77 years, and approximately 71% of them were female. The incidence of CSF leaks was 9% (95% CI: 0.06-0.12) (Figure 1), the overall complication rate was 6% (95% CI: 0.00-0.13) (Figure 2), major complications were noted in 21% of cases (95% CI: 0.12-0.30) (Figure 3), and minor complications showed a rate of 6% (95% CI: 0.00-0.13) (Figure 4).
Conclusion: Despite the complex anatomical challenges and inherent risks, the extended transsphenoidal approach demonstrated a relatively low complication rate and an acceptable length of hospital stay. This method showed significantly lower CSF leak and complication rates compared to previously published studies from the last decade.
Figure 1: CSF leak rates
Figure 2: Overall complications
Figure 3: Major postoperative complications
Figure 4: Minor postoperative complications
