Combined cranionasal surgery for spheno-orbital meningiomas invading the paranasal sinuses, pterygopalatine, and infratemporal fossa.
OBJECTIVE
To evaluate the efficacy of combining an endonasal endoscopic skull-base approach and repair with a transcranial orbitozygomatic approach for spheno-orbital meningiomas (SOMs).


METHODS
Three patients with recurrent SOMs underwent combined orbitozygomatic and endonasal endoscopic surgery. In 2 patients both procedures were done in 1 operation and in 1 patient the endonasal surgery was done 2.5 months after the craniotomy. Extent of resection, complications, morbidity, and mortality were evaluated.


RESULTS
Gross total resection was achieved in 1 patient and near total resection in the other 2 patients with tumor left in the cavernous sinus and parapharyngeal space. Two patients suffered cranial neuropathy from the transcranial surgery and the other developed a pseudomeningocele. There were no complications from the endonasal surgery. Patients having combined single setting cranionasal surgery were discharged on day 6 and 8, whereas the patient having only the endonasal component on a later date was discharged on day 2.


CONCLUSIONS
A combined cranionasal approach involving transcranial orbitozygomatic and endonasal endoscopic approaches is an effective 2-stage surgery for resecting SOMs invading into the sinuses and paranasal compartments. The ability to perform a multilayer closure involving a vascularized nasoseptal flap additionally decreases the risk of postoperative cerebrospinal fluid leak.
Department of Neurosurgery, Weill Cornell Medical College, New York Presbyterian Hospital, New York, New York, USA.
Moshe
M
Attia
Kunal S
KS
Patel
Jothy
J
Kandasamy
Philip E
PE
Stieg
Henry M
HM
Spinelli
Howard A
HA
Riina
Vijay K
VK
Anand
Theodore H
TH
Schwartz
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D035262:Cranial Fossa, Anterior / Q000473:pathology / Q000601:surgery*; D003399:Craniotomy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008579:Meningioma / Q000473:pathology / Q000601:surgery*; D008588:Meningocele / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D009296:Nasal Cavity / Q000601:surgery; D044583:Neuroendoscopy; D019635:Neurosurgical Procedures; D009915:Orbit / Q000601:surgery; D009918:Orbital Neoplasms / Q000473:pathology / Q000601:surgery*; D010256:Paranasal Sinuses / Q000473:pathology / Q000601:surgery*; D056739:Pterygopalatine Fossa / Q000473:pathology / Q000601:surgery*; D012888:Skull Neoplasms / Q000473:pathology / Q000601:surgery*; D013100:Sphenoid Bone / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D014787:Vision Tests; D014794:Visual Fields; D015050:Zygoma / Q000601:surgery