Visual Outcomes in Surgically Treated Intracranial Meningiomas

A Low Subfrontal Dural Opening for Operative Management of Anterior Skull Base Lesions

Introduction A low subfrontal dural opening technique that limits brain manipulation was assessed in patients that underwent frontotemporal approaches for anterior fossa lesions. Methods A retrospective review was performed for cases using a low subfrontal dural opening including characterization of demographics, lesion size and location, neurological and ophthalmological assessments, clinical course, and imaging findings. Results A low subfrontal dural opening was performed in 23 patients (17F, 6M), median age of 53 years (range 23-81) with median follow-up duration of 21.9 months (range 6.2-67.1). Lesions included 22 meningiomas (9 anterior clinoid, 12 tuberculum sellae, and 1 sphenoid wing), 1 unruptured internal carotid artery aneurysm clipped during a meningioma resection, and 1 optic nerve cavernous malformation. Maximal possible resection was achieved in all cases including gross total resection in 16/22 (72.7%), near total in 1/22 (4.5%), and subtotal in 5/22 (22.7%) in which tumor involvement of critical structures limited complete resection. Eighteen patients presented with vision loss; 11 (61%) improved postoperatively, 3 (17%) were stable, and 4 (22%) worsened. The mean ICU stay and time to discharge was 1.3 days (range 0-3) and 3.8 days (range 2-8). Conclusions A low subfrontal dural opening for approaches to the anterior fossa can be performed with minimal brain exposure, early visualization of the optico-carotid cistern for cerebrospinal fluid release, minimizing need for fixed brain retraction and Sylvian fissure dissection. This technique can potentially reduce surgical risk and provide excellent exposure for anterior skull base lesions with favorable extent of resection, visual recovery, and complication rates.