Endoscopic Endonasal Craniofacial Surgery for Recurrent Skull Base Meningiomas Involving the Pterygopalatine Fossa, the Infratemporal Fossa, the Orbit, and the Paranasal Sinus

• Published in: World neurosurgery 2018-04, Vol.112, p.e302-e312
• Main Authors: Shin, Masahiro, Shojima, Masaaki, Kondo, Kenji, Hasegawa, Hirotaka, Hanakita, Shunya, Ito, Akihiro, Kin, Taichi, Saito, Nobuhito
• Format: Article
• Language: English
• Subjects: Craniofacial meningioma; Craniofacial surgery; Endoscopic endonasal surgery; Infratemporal fossa; Orbit; Pterygopalatine fossa; Skull base meningioma
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2018.01.041

Skull base meningiomas carry a nonnegligible risk of recurrence. In particular, those arising from the sphenoid wings or middle cranial fossa penetrate into extracranial regions, uncommonly showing massive expansion into the craniofacial regions on recurrence. The role of endoscopic endonasal surgery for those intractable lesions remains unclear. We performed endoscopic endonasal craniofacial surgery for 8 recurrent meningiomas invading into the pterygopalatine fossa, infratemporal fossa, nasopharynx, paranasal sinus, or orbit, comprising 2 meningothelial and 1 fibrous meningiomas (World Health Organization [WHO] grade I), 3 atypical and 1 clear cell meningiomas (grade II), and 1 anaplastic meningioma (grade III). All were large (15–80 cm3; median, 45 cm3) and highly vascularized. All 8 tumors were sufficiently resected. Gross total resection of the craniofacial part of the lesions was achieved in 5 patients (62.5%). In 3 patients with WHO grade I meningiomas and 1 with grade II, tumors were successfully controlled as of the last follow-up. In 4 patients with WHO grade II or III meningiomas, craniofacial lesions were controlled, whereas original intracranial lesions were poorly controlled and became critical. We consider the endoscopic endonasal approach as an acceptable, less-invasive alternative for recurrent craniofacial meningioma. Although all these cases were relatively large and highly vascularized, preoperative endovascular embolization of the feeding arteries contributes to significantly reducing vascularity of the tumors, and local control of the craniofacial lesions was successfully achieved in all cases. Endoscopic endonasal craniofacial surgery enabled sufficient mass reduction without disfiguring facial incisions. •Outcomes of endoscopic endonasal surgery for recurrent craniofacial meningiomas.•All the cases are large, fibrous, and highly vascularized.•Local control of the craniofacial lesions was successfully achieved in all.•Endoscopic approach as a less-invasive alternative for craniofacial meningiomas.