title: Results with Expanded Endonasal Resection of Skull Base Meningiomas Technical Nuances and Approach Selection Based on an Early Experience.
abstract: OBJECTIVE
  Reconstruction technique advances have created renewed enthusiasm for the expanded endonasal approach (EEA). However, as with any new technique, early experiences inevitably lead to more selective use of these techniques. We reviewed our experience of the expanded endonasal endoscopic approach for skull base meningiomas and place it in context of the literature.
  
  
  METHODS
  We performed retrospective review of all endonasal cases performed at our center for histologically proven meningioma. Tumor locations in 26 patients included the olfactory groove (n=9), tuberculum sellae (n=7), optic nerve sheath (n=1), planum sphenoidale (n=2), clival (n=1) petroclival (n=3), cavernous sinus (n=2) and extensive pan-basal meningioma (n=1).
  
  
  RESULTS
  The median follow-up was 38.6 months. Excluding 3 patients with tumors found incidentally, pre-operative symptoms improved in 14 of 23 (61%), were the same in 8 of 23 (35%) and worsened in one of 23 patients (4%) at time of last follow-up. Of all 26 patients, 16 (62%) had complete macroscopic resection of their tumor, 5 (19%) underwent at least 90% resection, and 5 (19%) underwent subtotal resection. There were two neurological complications and one cerebrospinal fluid leak.
  
  
  CONCLUSIONS
  This study presents outcomes of patients treated with endonasal endoscopic meningioma surgery. We believe that very low rates of morbidity can be achieved in carefully selected patients, thus avoiding brain manipulation.
authors.affiliation: University Hospital of Wales, Department of Neurosurgery, Cardiff, United Kingdom.
authors.forename: Caroline
authors.initials: C
authors.lastname: Hayhurst
authors.forename: Michael E
authors.initials: ME
authors.lastname: Sughrue
authors.forename: Pankaj A
authors.initials: PA
authors.lastname: Gore
authors.forename: Phillip A
authors.initials: PA
authors.lastname: Bonney
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Burks
authors.forename: Charles
authors.initials: C
authors.lastname: Teo
mesh_terms: D000328:Adult; D000368:Aged; D004724:Endoscopy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000601:surgery*; D008579:Meningioma / Q000601:surgery*; D008875:Middle Aged; D009666:Nose / Q000601:surgery*; D012189:Retrospective Studies; D019292:Skull Base Neoplasms / Q000601:surgery*; D016896:Treatment Outcome