title: Endoscopic endonasal resection of anterior skull base meningiomas.
abstract: OBJECTIVE
  Anterior cranial fossa (ACF) meningiomas are difficult to surgically manage. Endoscopic transnasal approaches have increasingly been used as a minimally invasive route and thus offer significant advantages. However, a paucity of literature describing the intraoperative challenges and postoperative outcomes of this technique still exists.
  
  
  METHODS
  Case series with chart review.
  
  
  METHODS
  The Royal Adelaide Hospital, Flinders Medical Centre, Wellington Hospital.
  
  
  METHODS
  Fifteen consecutive patients who underwent endoscopic resection of ACF meningiomas between 2004 and 2010 by the South Australian and Wellington Skull Base Units. Demographic and clinical information was compiled by reviewing patient charts and operation notes. Safety and efficacy of the procedure, role of a team approach, and areas for further improvement were analyzed.
  
  
  RESULTS
  Of the patients, 87% were women. Tumor locations: 8 olfactory groove, 2 tuberculum sellae, 1 clinoidal, 1 jugum sphenoidale, 1 planum sphenoidale, 1 subfrontal, and 1 midline ACF floor. Commonest presenting symptom was visual change. Mean volume of tumor was 25.69 cm(3), with a size area of 7.28 cm(2). Five were revision cases. None had previous endonasal surgery. Average operating times decreased over time. Gross total removal was achieved in 14, with no deaths. Four patients had postoperative cerebrospinal fluid (CSF) leak. Rate of CSF leak decreased over time. Sixty percent of patients reported visual improvement. Two patients had radiological evidence of recurrence.
  
  
  CONCLUSIONS
  ACF meningiomas can be safely removed endonasally, offering significant advantages over the traditional transcranial approach for suitable tumors. Early audit of this approach shows results achieved by this unit are comparable with the published literature.
authors.affiliation: Department of Otolaryngology, The Queen Elizabeth Hospital, South Australia, Australia. vikram.padhye@gmail.com
authors.forename: Vikram
authors.initials: V
authors.lastname: Padhye
authors.forename: Yuresh
authors.initials: Y
authors.lastname: Naidoo
authors.forename: Hamish
authors.initials: H
authors.lastname: Alexander
authors.forename: Stephen
authors.initials: S
authors.lastname: Floreani
authors.forename: Simon
authors.initials: S
authors.lastname: Robinson
authors.forename: Stephen
authors.initials: S
authors.lastname: Santoreneos
authors.forename: Agadha
authors.initials: A
authors.lastname: Wickremesekera
authors.forename: Brian
authors.initials: B
authors.lastname: Brophy
authors.forename: Marguerite
authors.initials: M
authors.lastname: Harding
authors.forename: Nick
authors.initials: N
authors.lastname: Vrodos
authors.forename: Peter-John
authors.initials: PJ
authors.lastname: Wormald
mesh_terms: D000328:Adult; D000368:Aged; D035262:Cranial Fossa, Anterior / Q000601:surgery; D004724:Endoscopy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000175:diagnosis / Q000601:surgery*; D008579:Meningioma / Q000175:diagnosis / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology; D012189:Retrospective Studies; D013021:South Australia; D013996:Time and Motion Studies