Cranial nerve outcomes after surgery for frontal skull base meningiomas: the eternal quest of the maximum-safe resection with the lowest morbidity.

Cranial nerve outcomes after surgery for frontal skull base meningiomas: the eternal quest of the maximum-safe resection with the lowest morbidity.

World Neurosurg. 2019 Feb 07;:

Authors: Schneider M, Schuss P, Güresir Á, Wach J, Hamed M, Vatter H, Güresir E

Abstract
PURPOSE: Maximal aggressive meningioma resection is suggested to provide for the best tumor control rates. However, radical surgery of meningiomas located at the frontal skull base may be accompanied by the impairment of adjacent cranial nerve function that negatively impacts patient quality of life. We therefore analyzed our institutional database with regard to new cranial nerve deficits as well as postoperative CSF-leakage depending on the extent of tumor resection.
METHODS: Between February 2009 and April 2017, 195 patients underwent resection of frontal skull base meningioma at the authors´ institution. Postoperative new deficits of cranial nerve function as well as CSF-leakage were stratified into Simpson grade I resections with excision of the dural tail as an aggressive surgical approach versus Simpson grade II-V resections.
RESULTS: Simpson grade I resection was associated with a significantly higher percentage of new cranial nerve deficits immediately after surgery (30%) compared to Simpson grade II (13%, p=0.007) and Simpson grade II-V (17%, p=0.035). Differences aggravated for the twelve months follow up (29% Simpson grade I, 6% Simpson grade II (p<0.001), 10% Simpson grade II-V (p=0.001)). Postoperative CSF leakage occurred in 10.1% of Simpson grade I versus 2.3% in case of Simpson grade II resections (p=0.048). Retreatment rates did not differ between these two groups (2.5% versus 3.4% (p=1.000)).
CONCLUSIONS: High levels of new cranial nerve mobidity as well as CSF-leakage following radical removal of frontal skull base meningiomas including the adjacent dura are supposed to give way to a less aggressive surgery regime of frontobasal meningioma.

PMID: 30738945 [PubMed - as supplied by publisher]

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