Meningiomas of the anterior and middle cranial fossa: decision-making strategy for approach and results of the 10-year surgical experience in the neurosurgical department of “ICDC”

Surgical approach selection is one of the main questions in skull base surgery that mostly determines the successful outcome of the surgery.

THE OBJECTIVES OF THIS STUDY are the decision-making tactics for approach selection and the results of the surgical treatment of patients with anterior and middle skull base meningiomas.

MATERIALS AND METHODS: There were performed 245 surgeries of removal anterior and middle skull base meningiomas in the department of neurosurgery of the “Interregional Clinical and Diagnostic Center” (ICDC) with a mortality rate of 2,8 % in the period from 2010 to 2020 years.

RESULTS: The decision-making algorithm includes such criteria as the size and location of the tumor, involvement of neural and vascular structures in the tumor’s stroma and safety and efficacy properties of the surgical approach. The common approaches that are used in the department of neurosurgery of ICDC are unilateral subfrontal, transbasal bifrontal, pterional, modified orbitozygomatic, supraorbital eyebrow, and endoscopic transnasal approaches. Thus, the tumor can be attacked by multiple angles with the most effective and safe trajectory. In some cases, it is advisable to stage the tumor removal using approaches with different trajectories or combine transcranial and endoscopic approaches to facilitate the radicalism and safety of the surgery.

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