Page 918 - Read Online

Azab et al. Mini-invasive Surg 2020;4:88 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2020.75

Review Open Access

Endoscope-assisted transcranial surgery for
anterior skull base meningiomas

Waleed A. Azab, Mohamed A. Elmaghraby, Salem N. Zaidan, Kamal H. Mostafa

Neurosurgery Department, Ibn Sina Hospital, Kuwait City, Safat 13115, Kuwait.
Correspondence to: Dr. Waleed A. Azab, Neurosurgery Department, Ibn Sina Hospital, P.O Box: 25427, Kuwait City, Safat 13115,
Kuwait. E-mail: waleedazab@hotmail.com

How to cite this article: Azab WA, Elmaghraby MA, Zaidan SN, Mostafa KH. Endoscope-assisted transcranial surgery for
anterior skull base meningiomas. Mini-invasive Surg 2020;4:88. http://dx.doi.org/10.20517/2574-1225.2020.75

Received: 20 Jul 2020 First Decision: 26 Aug 2020 Revised: 4 Sep 2020 Accepted: 10 Oct 2020 Published: 10 Dec 2020

Academic Editor: Oreste de Divitiis Copy Editor: Cai-Hong Wang Production Editor: Jing Yu

Abstract
Anterior skull base meningiomas are benign, dural-based tumors that originate from the tuberculum sellae,
planum sphenoidale or olfactory groove. A multitude of traditional transcranial approaches have been effectively
used for resection of these tumors. However, in the era of minimally invasive neurosurgery, the endoscopic
endonasal and the endoscope-assisted or endoscope-controlled supraorbital keyhole eyebrow approaches stand
out as the two main options utilized to resect these tumors. The supraorbital keyhole approach minimizes brain
retraction, tissue dissection and length of the skin incision. Consequently, this approach is associated with a lower
complication profile and much better cosmetic results in comparison to classic approaches. With endoscopic
assistance or control, the approach provides an excellent view of anterior skull base meningiomas and enables
optic nerve decompression when angled scopes are used. In our opinion, endoscopes will ultimately replace
the surgical microscopes as the viewing tools in this type of surgery. A limited number of studies have directly
compared the endoscopic endonasal approach versus the supraorbital keyhole one for resection of anterior
cranial base meningiomas. In these studies, scores and algorithms have been suggested to help select the suitable
approach. The practical value of these algorithms still needs to be validated by further research. Although the
endoscope-assisted or -controlled supraorbital keyhole approach offers a minimally invasive and highly effective
approach for excision of anterior cranial base meningiomas, the ideal approach should be tailored to the individual
patient according to the tumor size, lateral extension, optic canal involvement, extent of vascular encasement and
surgeon’s experience.

Keywords: Endoscope, endoscope-assisted, keyhole, meningioma, olfactory groove, planum sphenoidal, skull base,
tuberculum sellae

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license,
and indicate if changes were made.

www.misjournal.net