title: Open Transcranial Resection of Small (<35 mm) Meningiomas of the Anterior Midline Skull Base in Current Microsurgical Practice.
abstract: OBJECTIVE
  Despite technical surgical advance, the ultimate management of midline anterior skull base meningiomas remains to be defined. Open transcranial surgery is usually the first treatment option for large meningiomas, while less invasive techniques such as endoscopic surgery or radiosurgery might represent an alternative to open microsurgery for smaller lesions. The aim of our study is to investigate the outcome of open transcranial microsurgery in the resection of small (<35 mm) meningiomas of the midline anterior cranial base.
  
  
  METHODS
  Clinical and surgical data from 43 patients affected by small midline anterior skull base meningiomas operated via an open transcranial approach were retrospectively reviewed.
  
  
  RESULTS
  The tumor diameter on its major axis ranged from 12 to 35 mm, with a mean diameter of 28 mm. Gross total resection (Simpson grades I-II) was achieved in 100% of cases through a pterional approach. Postoperative overall morbidity was 9%. It was 3% among patients <70 years. No mortality was reported. Postoperative visual outcome was significantly associated with preoperative visual performance (P = 0.02), but not with preoperative optic nerve compression as detected by magnetic resonance imaging (P = 0.116). Age >70 years was associated with postoperative visual impairment, although not significantly (P = 0.06). Visual function was preserved or improved in 95% of cases, in 100% of patients <70 years, and in 71% of patients with preoperative visual impairment.
  
  
  CONCLUSIONS
  In our experience, open transcranial surgery proved safe and effective for midline anterior skull base meningiomas smaller than 35 mm in all patients <70 years and in patients >70 years without preoperative visual deficit. Our data are consistent with the literature. Conversely, the standard of treatment for the subgroup of patients >70 years with preoperative visual deficit has not yet been defined. This specific subgroup of patients offers a topic for further investigation.
authors.affiliation: Department of Neurosurgery, Padua University Hospital, Padua, Italy. Electronic address: alessandro.dellapuppa@sanita.padova.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Della Puppa
authors.affiliation: Department of Neurosurgery, Padua University Hospital, Padua, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: d'Avella
authors.affiliation: Department of Neurosurgery, Padua University Hospital, Padua, Italy.
authors.forename: Marta
authors.initials: M
authors.lastname: Rossetto
authors.affiliation: Department of Neurosurgery, Padua University Hospital, Padua, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Volpin
authors.affiliation: Department of Neurosurgery, Padua University Hospital, Padua, Italy.
authors.forename: Oriela
authors.initials: O
authors.lastname: Rustemi
authors.affiliation: Department of Neurosurgery, Padua University Hospital, Padua, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Gioffrè
authors.affiliation: Department of Oncology, IOV IRCCS Oncology Institute of Padua, Padua, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lombardi
authors.affiliation: Neuroradiology Unit, Padua University Hospital, Padua, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Rolma
authors.affiliation: Department of Neurosurgery, Padua University Hospital, Padua, Italy.
authors.forename: Renato
authors.initials: R
authors.lastname: Scienza
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008579:Meningioma / Q000473:pathology / Q000601:surgery*; D008866:Microsurgery / Q000379:methods* / Q000401:mortality; D008875:Middle Aged; D009422:Nervous System Diseases / Q000453:epidemiology / Q000209:etiology / Q000523:psychology; D019635:Neurosurgical Procedures / Q000379:methods* / Q000401:mortality; D011183:Postoperative Complications / Q000453:epidemiology / Q000523:psychology; D012189:Retrospective Studies; D019291:Skull Base / Q000473:pathology / Q000601:surgery*; D019292:Skull Base Neoplasms / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D014785:Vision, Ocular
keywords: Endoscopic; Microsurgery; Midline anterior fossa meningiomas; Skull base; Small meningiomas; Surgical outcome