Surgical treatment and outcome of skull base meningiomas with extracranial extensions.
OBJECTIVE
Recurrent cranial base meningiomas occasionally extend into craniofacial structures, and are one of the most difficult tumors to surgically manage. We reviewed our experience of surgical treatment in a series of patients with meningiomas showing extensive extracranial extensions.


METHODS
We surgically treated a total of 10 patients with recurrent cranial base meningiomas with large extension to multiple craniofacial structures. All patients underwent orbitozygomatic or zygomatic frontotemporal craniotomy for surgical resection of the tumor. An endoscopic endonasal technique was also employed, if necessary, as an adjunct to the transcranial approach.


RESULTS
Eight patients were treated solely with a frontotemporal approach associated with an extended resection of the floor of the middle fossa. In 2 patients, an endoscopic endonasal approach was additionally required for resection of tumors located in the nasal cavity and ethmoid sinus. A gross total resection was achieved without serious surgical complications in 9 out of the 10 patients. In all patients, the tumors were found to invade the surrounding tissue such as the bone and skeletal muscle to varying degrees.


CONCLUSIONS
Our data indicate that recurrent craniofacial meningiomas can usually be managed by using a lateral cranial base approach. Whereas it would be expected that a radical resection may prevent further recurrence with an acceptable quality of life, a long-term follow-up would be required for confirming the benefit of this treatment strategy.
Nakao
Naoyuki
N
Department of Neurological Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama 641-0012, Japan. nnakao@wakayama-med.ac.jp
Ohkawa
Toshika
T
Miki
Junichirou
J
Ogura
Mitsuhiro
M
Itakura
Toru
T
D000368:Aged; D000768:Anesthesia, General; D001766:Blindness / Q000209:etiology; D035301:Cranial Fossa, Middle / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008579:Meningioma / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D009422:Nervous System Diseases / Q000209:etiology / Q000503:physiopathology; D019635:Neurosurgical Procedures; D009886:Ophthalmoplegia / Q000209:etiology; D010033:Otitis Media / Q000209:etiology; D011183:Postoperative Complications / Q000503:physiopathology; D019292:Skull Base Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D016896:Treatment Outcome