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Avery et al. Mini-invasive Surg 2021;5:17 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2021.05

Review Open Access

Endoscopic endonasal surgery for anterior skull

base meningiomas

1,2
1,2
Michael B. Avery , Garni Barkhoudarian , Daniel F. Kelly 1,2
1
Pacific Neuroscience Institute, Santa Monica, CA 90404, USA.
2
Saint John's Cancer Institute, Providence Saint John’s Health Center, Santa Monica, CA 90404, USA.
Correspondence to: Dr. Daniel F. Kelly, Pacific Neuroscience Institute, 2125 Arizona Avenue, Santa Monica, CA 90404, USA.
E-mail: dkelly@pacificneuro.org
How to cite this article: Avery MB, Barkhoudarian G, Kelly DF. Endoscopic endonasal surgery for anterior skull base
meningiomas. Mini-invasive Surg 2021;5:17. https://dx.doi.org/10.20517/2574-1225.2021.05

Received: 14 Jan 2021 First Decision: 19 Feb 2021 Revised: 6 Apr 2021 Accepted: 8 Apr 2021 Available online: 17 Apr 2021

Academic Editors: Giulio Belli, Oreste de Divitiis Copy Editor: Xi-Jun Chen Production Editor: Xi-Jun Chen

Abstract
Meningiomas of the tuberculum sellae, planum sphenoidale and olfactory groove region are relatively common.
Traditionally these meningiomas have been approached through several transcranial approaches. More recently,
keyhole approaches have been utilized with success even for large tumors. Endoscopic approaches are an
extension of this philosophy, which, in carefully selected patients, may be an excellent alternative, offering a direct
line of site from an endonasal approach without brain retraction. Furthermore, bilateral optic canal decompression
can be safely and effectively accomplished. We propose that a majority of tuberculum sellae and posterior planum
meningiomas may be removed via an endonasal approach, particularly those that are 3 cm or smaller in maximal
diameter with minimal lateral extension beyond the supraclinoid carotid arteries and with medial optic canal
invasion. A deepened sella is also a favorable factor for endonasal removal. In contrast, we propose that a minority
of olfactory groove meningiomas are ideal candidates for endoscopic trans-cribriform removal given the higher risk
of anosmia and cerebrospinal fluid leak via the nasal corridor. Instead, a majority of these tumors can be safely and
effectively removed via a transcranial keyhole approach, such as the supraorbital “eyebrow” craniotomy or
traditional pterional craniotomy with a higher rate of olfaction preservation.

Keywords: Meningioma, endoscopy, anterior skull base, tuberculum sellae, planum sphenoidale, olfactory groove,
optic canal decompression

INTRODUCTION
The era of endoscopic transsphenoidal surgery began in the late 1990s, bringing with it improvement of

© The Author(s) 2021. Open Access This article is licensed under a Creative Commons Attribution 4.0
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