Management of Intracranial Meningiomas Using Keyhole Techniques.
BACKGROUND
Keyhole craniotomies are increasingly being used for lesions of the skull base. Here we review our recent experience with these approaches for resection of intracranial meningiomas.


METHODS
Clinical and operative data were gathered on all patients treated with keyhole approaches by the senior author from January 2012 to June 2013. Thirty-one meningiomas were resected in 27 patients, including 9 supratentorial, 5 anterior fossa, 7 middle fossa, 6 posterior fossa, and 4 complex skull base tumors. Twenty-nine tumors were WHO Grade I, and 2 were Grade II.


RESULTS
The mean operative time was 8 hours, 22 minutes (range, 2:55-16:14) for skull-base tumors, and 4 hours, 27 minutes (range, 1:45-7:13) for supratentorial tumors. Simpson Resection grades were as follows: Grade I = 8, II = 8, III = 1, IV = 15, V = 0. The median postoperative hospital stay was 4 days (range, 1-20 days). In the 9 patients presenting with some degree of visual loss, 7 saw improvement or complete resolution. In the 6 patients presenting with cranial nerve palsies, 4 experienced improvement or resolution of the deficit postoperatively. Four patients experienced new neurologic deficits, all of which were improved or resolved at the time of the last follow-up. Technical aspects and surgical nuances of these approaches for management of intracranial meningiomas are discussed.


CONCLUSIONS
With careful preoperative evaluation, keyhole approaches can be utilized singly or in combination to manage meningiomas in a wide variety of locations with satisfactory results.
Department of Neurosurgery, University of Oklahoma Health Sciences Center.
Joshua D
JD
Burks
Department of Neurosurgery, University of Oklahoma Health Sciences Center.
Andrew K
AK
Conner
Department of Neurosurgery, University of Oklahoma Health Sciences Center.
Phillip A
PA
Bonney
Department of Neurosurgery, Indiana University School of Medicine.
Jacob B
JB
Archer
Department of Anesthesiology, University of Oklahoma Health Sciences Center.
Blake
B
Christensen
Department of Anesthesiology, University of Oklahoma Health Sciences Center.
Jacqueline
J
Smith
Department of Neurosurgery, University of Oklahoma Health Sciences Center.
Sam
S
Safavi-Abbasi
Department of Neurosurgery, University of Oklahoma Health Sciences Center.
Michael
M
Sughrue
craniotomy; eyebrow; keyhole; meningioma; pterional; retrosigmoid; supraorbital; tumor resection