Publication year: 2012
Source:World Neurosurgery
Moshe Attia, Kunal S. Patel, Jothy Kandasamy, Philip E. Stieg, Henry M. Spinelli, Howard A. Riina, Vijay K. Anand, Theodore H. Schwartz
Objectives To evaluate the efficacy of combining an endonasal endoscopic skull base approach and repair with a transcranial orbitozygomatic approach for Spheno-orbital meningiomas (SOMs). Methods Three patients with recurrent SOMs were underwent combined orbitozygomatic and endonasal endoscopic surgery. In two patients both procedures were done in one operation and in one patient the endonasal surgery was done 2.5 months after the craniotomy. Extent of resection, complications, morbidity and mortality were evaluated. Results GTR was achieved in one patient and near total resection in the other two with tumor left in the cavernous sinus and parapharyngeal space. Two patients suffered cranial neuropathy from the transcranial surgery and the other developed a pseudomeningocele. There were no complications from the endonasal surgery. Patients having combined single setting cranionasal surgery were discharged on day 6 and 8 whereas the patient having only the endonasal component on a later date was discharged on day 2. Conclusion A combined cranionasal approach involving transcranial orbitozygomatic and endonasal endoscopic approaches is an effective two-stage surgery for resecting SOMs invading into the sinuses and paranasal compartments. The ability to perform a multilayer closure involving a vascularized nasoseptal flap additionally decreases the risk of post-operative CSF leak.
Júlio Leonardo B. Pereira
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