Endoscopic endonasal approaches for the management of skull base meningiomas: selection criteria and clinical outcomes

Closure of Skull Base Defects after Endonasal Endoscopic Resection of Planum Sphenoidale and Tuberculum Sellae Meningiomas

Background

The expanded endoscopic endonasal transplanum transtuberculum approach allows tumor removal by minimally invasive procedures. A large dural and bone defect is created during the surgical procedure, increasing the risk of postoperative cerebrospinal fluid (CSF) leakage.

Objective

The aim of this study is to describe a surgical technique and complications observed in patients undergoing endonasal resection of planum sphenoidale and/or tuberculum sellae meningiomas.

Methods

A retrospective analysis was performed of patients with planum sphenoidale and/or tuberculum sellae meningiomas after expanded endoscopic endonasal resection between June 2013 and August 2018, in which autologous grafts, fascia lata inlay, and nasoseptal flap onlay were used for closure of skull base defects.

Results

Ten patients were included in the analysis. No cases of postoperative CSF leakages or meningitis were reported, whereas two patients evolved with postoperative infectious complications (fungal ball in right frontal sinus and brain abscess). The skull base defect created for resection measured, on average, 3.58 cm².

Conclusion

Our experience suggests that closure of skull base defects using combined fascia lata inlay and nasoseptal flap onlay is effective for preventing postoperative CSF leakage in resection of planum sphenoidale and/or tuberculum sellae meningiomas, and offers high reproducibility due to its low cost.