Ya-Jui Lin1, Ko-Ting Chen1, Cheng-Chi Lee2, Cheng-Hong Toh3, Tai-Wei Erich Wu1, Yin-Cheng Huang1, Peng-Wei Hsu1, Yu-Jen Lu1, Chi-Cheng Chuang1, Pin-Yuan Chen4, Kuo-Chen Wei1. 1. Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou, Taiwan. 2. Department of Neurosurgery, Chang Gung Memorial Hospital, Linkou, Taiwan; Institute of Biomedical Engineering National Taiwan University, Taipei, Taiwan. 3. Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan; Chang Gung University, Taoyuan, Taiwan. 4. Department of Neurosurgery, Chang Gung Memorial Hospital, Keelung, Taiwan; Department of Neurosurgery, Linkou Chang-Gung Memorial Hospital and School of Medicine, Chang Gung University, Taoyuan City, Taiwan. Electronic address: pinyuanc@gmail.com.
Abstract
BACKGROUND: The prognosis and recurrence rate after resection of an anterior skull base lesion via transciliary supraorbital keyhole craniotomy depend on residual tumor volume. The extent to which pathology and size of tumor influence the resection rate using this approach is unknown. METHODS: Sixty-two patients underwent a total of 64 operations using the supraorbital keyhole approach in this retrospective study. Meningioma was the most common tumor, followed by pituitary adenoma and craniopharyngioma. Age, sex, tumor volume, operative duration, blood loss, and complication rates were evaluated. Pre- and postoperative residual tumor volumes were measured using OsiriX software (medical image viewer system) based on magnetic resonance imaging. A 15-mL cut value divided the subjects into large versus small meningioma groups. RESULTS: The average resection rate for meningiomas was 95.2% compared with 83.9% for craniopharyngiomas and 53.2% for pituitary adenomas. The major complication rate (primarily blindness and hemiplegia) was 4.48% in all tumors. No operative-related deaths occurred. There were no surgical revisions to traditional large craniotomies. No significant differences in age, sex, postoperative volumes, resection rates, or recurrence rates were noted between small and large meningioma groups. However, longer operative times and hospital stays, and greater blood loss occurred in the large meningioma group. CONCLUSIONS: Transciliary keyhole craniotomy is a safe and effective approach for anterior skull base tumors, especially meningiomas. Excellent resection results were achieved even in cases of large meningiomas. Although longer operative times, longer hospital stays, and greater blood loss occurred in larger compared with smaller meningioma cases, recurrence rates were similar.
BACKGROUND: The prognosis and recurrence rate after resection of an anterior skull base lesion via transciliary supraorbital keyhole craniotomy depend on residual tumor volume. The extent to which pathology and size of tumor influence the resection rate using this approach is unknown. METHODS: Sixty-two patients underwent a total of 64 operations using the supraorbital keyhole approach in this retrospective study. Meningioma was the most common tumor, followed by pituitary adenoma and craniopharyngioma. Age, sex, tumor volume, operative duration, blood loss, and complication rates were evaluated. Pre- and postoperative residual tumor volumes were measured using OsiriX software (medical image viewer system) based on magnetic resonance imaging. A 15-mL cut value divided the subjects into large versus small meningioma groups. RESULTS: The average resection rate for meningiomas was 95.2% compared with 83.9% for craniopharyngiomas and 53.2% for pituitary adenomas. The major complication rate (primarily blindness and hemiplegia) was 4.48% in all tumors. No operative-related deaths occurred. There were no surgical revisions to traditional large craniotomies. No significant differences in age, sex, postoperative volumes, resection rates, or recurrence rates were noted between small and large meningioma groups. However, longer operative times and hospital stays, and greater blood loss occurred in the large meningioma group. CONCLUSIONS: Transciliary keyhole craniotomy is a safe and effective approach for anterior skull base tumors, especially meningiomas. Excellent resection results were achieved even in cases of large meningiomas. Although longer operative times, longer hospital stays, and greater blood loss occurred in larger compared with smaller meningioma cases, recurrence rates were similar.
Authors: Scott C Seaman; Muhammad S Ali; Anthony Marincovich; Luyuan Li; Jarrett E Walsh; Jeremy D W Greenlee Journal: J Neurol Surg B Skull Base Date: 2020-12-29