A Meta-Analysis of Endoscopic Endonasal versus Supraorbital Craniotomy Approaches for Anterior Skull Base Meningiomas

Introduction: Anterior skull base meningiomas of the olfactory Groove (OG) and planum sphenoidale/tuberculum sellae (PS/TS) regions present challenging targets for surgical resection. Common minimally invasive approaches to these tumors include endoscopic endonasal approach (EEA) and supraorbital craniotomy (SOC). Few reports directly compare these minimally invasive corridors. Thus, we reviewed the available literature and compared relevant clinical, patient-oriented outcomes between these approaches.

Patients/Methods: Due to the lack of available comparative studies, PUBMED and Web of Science were queried for single-arm observational and/or case series for anterior skull base meningioma outcomes using either SOC or EEA. A total of 321 articles were identified for screening, 42 of which ultimately satisfied inclusion criteria according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A meta-analysis of was then performed using a logit transformation of the data to analyze the probability of a given occurrence for each variable. Analyses were performed across all locations and stratified by OG or PS/TS.

Results: In the 42 studies satisfying inclusion criteria, 427 patients underwent surgery via SOC approach and 524 via EEA. SOC resulted in a significantly higher gross-total resection (GTR) rate in comparison with EEA (84.5 vs. 73.3%, p = 0.0006) across all locations, with significantly higher GTR for OG (90.5 vs. 65.9%, p < 0.0001) and a strong trend in GTR for PS/TS (81.9 vs. 74.3%, p = 0.0542). Across all locations, CSF leak rate was significantly higher with EEA than with SOC (18.5 vs. 7.2%, p < 0.0001), findings that persisted in OG (30.9 vs. 10.9%, p = 0.0003) and PS/TS (15.3 vs. 6.2%, p = 0.0020). Better visual outcomes were observed for the EEA cohort over SOC in both pooled and subgroup analyses, but this was not statistically significant. No difference in rates of stroke, seizure, or recurrence existed between approaches.

Conclusion: SOC demonstrated a more favorable tumor resection and CSF leak rate compared with the EEA approach, with no difference in vision, seizure, stroke, or recurrence outcomes. In cases without a visual deficit, our data suggest SOC to be the superior approach. However, in cases with a visual deficit, the data suggests a slightly more favorable outcome with EEA, although this was not a statistically significant advantage. In these cases of clinical equipoise, considerations of surgeon preference, anatomical and radiographic factors, and patient preference need to be carefully considered.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
12 February 2021