Combined cranionasal surgery for spheno-orbital meningiomas invading the paranasal sinuses, pterygopalatine, and infratemporal fossa

Moshe Attia, Kunal S. Patel, Jothy Kandasamy, Philip E. Stieg, Henry M. Spinelli, Howard A. Riina, Vijay K. Anand, Theodore H. Schwartz

Research output: Contribution to journalReview articlepeer-review

Abstract

Objective: 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 underwent combined orbitozygomatic and endonasal endoscopic surgery. In 2 patients both procedures were done in 1 operation and in 1 patient the endonasal surgery was done 2.5 months after the craniotomy. Extent of resection, complications, morbidity, and mortality were evaluated. Results: Gross total resection was achieved in 1 patient and near total resection in the other 2 patients 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. Conclusions: A combined cranionasal approach involving transcranial orbitozygomatic and endonasal endoscopic approaches is an effective 2-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 postoperative cerebrospinal fluid leak.

Original languageEnglish
Pages (from-to)e367-e373
JournalWorld Neurosurgery
Volume80
Issue number6
DOIs
StatePublished - Dec 2013
Externally publishedYes

Keywords

  • Endoscopic endonasal
  • Infratemporal fossa
  • Paranasal sinuses
  • Pterygopalatine fossa
  • Skull base
  • Spheno-orbital meningioma
  • Transpterygoid approach
  • Transsphenoidal approach

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