2026 Poster Presentations
P126: SKULL BASE MENINGIOMAS TREATED WITH ENDOSCOPIC ENDONASAL APPROACHES. CASE SERIES.
Bakhtiyar Pashaev, MD1; Arseniy Pichugin, PhD2; Gulnar Vagapova, MD3; Nail Shajakhmetov, MD1; 1Interregional Clinical Diagnostic Cwnter; 2Kazan State Medical University; 3Kazan State Medical Academy
Background: Meningiomas are typically benign, slow-growing tumors for which surgical resection is the primary treatment. Skull base meningiomas present a particular surgical challenge due to their proximity to critical neurovascular structures and potential for invasiveness.
Objective: To evaluate efficacy of endonasal endoscopic route in the surgical treatment of the skull base meningiomas.
Method: A retrospective review of the consecutive series of patients with skull base meningiomas treated with endoscopic endonasal approaches was conducted. Tumor location, type of approaches, extend of resection (EOR), complications and outcomes were analyzed.
Results: A patient’s cohort of 30 patients (9 male, 21 female) with skull base meningiomas of different locations were included in the study. The mean age of the patients was 56,8 years (range: 32-75). Tumors were located at the anterior (n=12), central (n=16) and posterior (n=2) skull base. Specific subtypes included olfactory groove meningiomas (n=5), tumors involving the ethmoid cells with optic canal invasion (n=5), and lesions with extracranial extension (n=2). At the central skull base there were tuberculum sellae meningiomas (n=8), cavernous sinus meningiomas (n=6), giant tumors of the sphenoid sinus with sellae turcica invasion (n=2). Two tumors were located at the clivus. All procedures were performed using purely endoscopic techniques, with expanded approaches employed as needed. Gross-total resection (GTR) was achieved in 15 patients (50%), subtotal resection in 5 (16.7%), and partial resection in 10 (33.3%). Combined simultaneous transcranial-endonasal approaches were utilized in two cases with significant extracranial extension. One patient with a giant olfactory groove meningioma underwent staged surgery, with initial endoscopic debulking for devascularization, followed by a subfrontal resection one month later. Postoperative improvement was noted in visual function (n=2) and a pre-existing CN VI palsy (n=1). A postoperative CSF leak occurred in 6 patients (20%). Other complications included meningitis (n=2, 6.7%), vascular injury (n=1, 3.3%), brain injury (n=1, 3.3%), significant blood loss (n=1, 3.3%), DVT (n=1, 3.3%), and diabetes insipidus (n=3, 10%). The perioperative mortality rate was 3.3% (n=1).
Conclusions: The endoscopic endonasal approach provides direct access to the tumor matrix, facilitating early devascularization and minimizing brain retraction. It is a valuable option for select skull base meningiomas, particularly those with extracranial extension. However, the approach presents challenges in vascular dissection, and CSF leakage remains a significant concern. The technique is associated with a steep learning curve.