title: Endoscope-assisted keyhole surgery via an eyebrow incision for removal of large meningiomas of the anterior and middle cranial fossa.
abstract: BACKGROUND
  Conventional open surgery of large meningiomas has proven to be challenging even in experienced hands. Intense retraction and dissection around neurovascular structures increase morbidity and mortality. In the present study, we retrospectively analyzed the surgical technique, and outcome in 40 patients with large anterior cranial fossa meningiomas extending to the middle fossa. All patients were approached via a supraorbital mini craniotomy.
  
  
  METHODS
  It is a retrospective study of 40 patients (12 males, 28 females) who underwent surgery for large anterior cranial fossa meningiomas (diameter >5 cm) extending to the middle fossa in four different neurosurgical centers within 6 years. Depending on the localization of the tumor, the skin incision was between 2.5 and 3 cm long and was made without shaving the patient's eyebrow hair. Subsequently, a keyhole craniotomy was performed of approximately 0.8×1.2-1.4 cm in diameter. Preoperative and postoperative clinical and radiological data were analyzed and discussed.
  
  
  RESULTS
  Headache and psycho-organic syndrome were the most common presenting symptom in all patients. Presenting symptoms were associated with psychological changes in 23 cases, visual impairment in 19 patients, and anosmia in 17 patients. In overall, 36 of 40 patients (90%) showed a good outcome and returned at long-term follow-up to their previous occupations. The elderly patients returned to their daily routine.
  
  
  CONCLUSIONS
  With the appropriate keyhole approach as a refinement of the classic keyhole craniotomy to a smaller key"burr"hole, and with use of modern and new designed equipment, it is possible to perform complete resection of large anterior and middle fossa meningiomas with the same safety, efficiency and with less complication rates as described in the literature for large meningiomas even performed with classic keyhole craniotomies.
authors.affiliation: Department of Neurosurgery, Hospital Merheim, University of Witten-Herdecke, Cologne, Germany.
authors.forename: Alhadi
authors.initials: A
authors.lastname: Igressa
authors.affiliation: Department of Neurosurgery, Hospital Merheim, University of Witten-Herdecke, Cologne, Germany.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Pechlivanis
authors.affiliation: Department of Neurosurgery, Hospital Merheim, University of Witten-Herdecke, Cologne, Germany.
authors.forename: Friedrich
authors.initials: F
authors.lastname: Weber
authors.affiliation: Department of Neurosurgery, Hospital Merheim, University of Witten-Herdecke, Cologne, Germany.
authors.forename: Mehran
authors.initials: M
authors.lastname: Mahvash
authors.affiliation: Department of Neurosurgery, University Medical Center Mainz, Mainz, Germany.
authors.forename: Ali
authors.initials: A
authors.lastname: Ayyad
authors.affiliation: Department of Neurosurgery, Mohamed Vth University, School of Medicine, Hôpital des Spécialités, ONO CHU Ibn Sina, Rabat, Morocco.
authors.forename: Mahjouba
authors.initials: M
authors.lastname: Boutarbouch
authors.affiliation: Department of Neurosurgery, Hospital Merheim, University of Witten-Herdecke, Cologne, Germany. Electronic address: charalampaki@yahoo.de.
authors.forename: Patra
authors.initials: P
authors.lastname: Charalampaki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D035262:Cranial Fossa, Anterior / Q000473:pathology / Q000601:surgery*; D035301:Cranial Fossa, Middle / Q000473:pathology / Q000601:surgery*; D005138:Eyebrows; D005260:Female; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000473:pathology / Q000601:surgery*; D008579:Meningioma / Q000175:diagnosis / Q000601:surgery*; D008875:Middle Aged; D044582:Neuroendoscopes; D019635:Neurosurgical Procedures / Q000379:methods; D012189:Retrospective Studies; D019292:Skull Base Neoplasms / Q000601:surgery; D016896:Treatment Outcome
keywords: Endoscope-assisted neurosurgery; Keyhole neurosurgery; Meningioma; Skull base surgery; Supraorbital approach