title: Pure endoscopic expanded endonasal approach for olfactory groove and tuberculum sellae meningiomas.
abstract: The expanded endoscopic endonasal (EEE) approach for the removal of olfactory groove (OGM) and tuberculum sellae (TSM) meningiomas is currently becoming an acceptable surgical approach in neurosurgical practice, although it is still controversial with respect to its outcomes, indications and limitations. Here we provide a review of the available literature reporting results with use of the EEE approach for these lesions together with our experience with the use of the endoscope as the sole means of visualization in a series of patients with no prior surgical biopsy or resection. Surgical cases between May 2006 and January 2013 were retrospectively reviewed. Twenty-three patients (OGM n=6; TSM n=17) were identified. In our series gross total resection (GTR) was achieved in 4/6 OGM (66.7%) and 11/17 (64.7%) TSM patients. Vision improved in the OGM group (2/2) and 8/11 improved in the TSM group with no change in visual status in the remaining three patients. Post-operative cerebrospinal fluid (CSF) leak occurred in 2/6 (33%) OGM and 2/17 (11.8%) TSM patients. The literature review revealed a total of 19 OGM and 174 TSM cases which were reviewed. GTR rate was 73% for OGM and 56.3% for TSM. Post-operative CSF leak was 30% for OGM and 14% for TSM. With careful patient selection and a clear understanding of its limitations, the EEE technique is both feasible and safe. However, longer follow-ups are necessary to better define the appropriate indications and ideal patient population that will benefit from the use of these newer techniques.
authors.affiliation: Division of Neurosurgery, University Health Network, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, Ontario M5T 2S8, Canada. Electronic address: osaama.h.khan@gmail.com.
authors.forename: Osaama H
authors.initials: OH
authors.lastname: Khan
authors.affiliation: Division of Neurosurgery, University Health Network, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, Ontario M5T 2S8, Canada.
authors.forename: Boris
authors.initials: B
authors.lastname: Krischek
authors.affiliation: Division of Neurosurgery, University Health Network, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, Ontario M5T 2S8, Canada.
authors.forename: Damian
authors.initials: D
authors.lastname: Holliman
authors.affiliation: Division of Neurosurgery, University Health Network, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, Ontario M5T 2S8, Canada.
authors.forename: George
authors.initials: G
authors.lastname: Klironomos
authors.affiliation: Department of Diagnostic Imaging, University Health Network, Toronto Western Hospital, University of Toronto, Ontario, Canada.
authors.forename: Walter
authors.initials: W
authors.lastname: Kucharczyk
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Mount Sinai Hospital, University of Toronto, Ontario, Canada.
authors.forename: Allan
authors.initials: A
authors.lastname: Vescan
authors.affiliation: Division of Neurosurgery, University Health Network, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, Ontario M5T 2S8, Canada.
authors.forename: Fred
authors.initials: F
authors.lastname: Gentili
authors.affiliation: Division of Neurosurgery, University Health Network, Toronto Western Hospital, University of Toronto, 399 Bathurst Street, Ontario M5T 2S8, Canada.
authors.forename: Gelareh
authors.initials: G
authors.lastname: Zadeh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; 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; D009296:Nasal Cavity / Q000601:surgery*; D044583:Neuroendoscopy / Q000379:methods*; D011446:Prospective Studies; D012189:Retrospective Studies; D012658:Sella Turcica / Q000473:pathology / Q000601:surgery*; D019292:Skull Base Neoplasms / Q000175:diagnosis / Q000601:surgery*
keywords: Anterior skull base; CSF leak; Minimally invasive; Naso-septal flap; Transcribiform; Transplanum; Transsphenoidal