Anterior Skull Base Tumor Resection by Transciliary Supraorbital Keyhole Craniotomy: A Single Institutional Experience.

BACKGROUND: The prognosis and recurrence rate after resection of an anterior skull base lesion via transciliary supraorbital keyhole craniotomy depend on residual tumor volume. The extent to which pathology and size of tumor influence the resection rate using this approach is unknown.

METHODS: Sixty-two patients underwent a total of 64 operations using the supraorbital keyhole approach in this retrospective study. Meningioma was the most common tumor, followed by pituitary adenoma and craniopharyngioma. Age, sex, tumor volume, operative duration, blood loss, and complication rates were evaluated. Pre- and postoperative residual tumor volumes were measured using OsiriX software (medical image viewer system) based on magnetic resonance imaging. A 15-mL cut value divided the subjects into large versus small meningioma groups.

RESULTS: The average resection rate for meningiomas was 95.2% compared with 83.9% for craniopharyngiomas and 53.2% for pituitary adenomas. The major complication rate (primarily blindness and hemiplegia) was 4.48% in all tumors. No operative-related deaths occurred. There were no surgical revisions to traditional large craniotomies. No significant differences in age, sex, postoperative volumes, resection rates, or recurrence rates were noted between small and large meningioma groups. However, longer operative times and hospital stays, and greater blood loss occurred in the large meningioma group.

CONCLUSIONS: Transciliary keyhole craniotomy is a safe and effective approach for anterior skull base tumors, especially meningiomas. Excellent resection results were achieved even in cases of large meningiomas. Although longer operative times, longer hospital stays, and greater blood loss occurred in larger compared with smaller meningioma cases, recurrence rates were similar.