The Neurosurgery Journal

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The role of endoscopic decompression of the optic chiasm and the optic nerve for skull base meningioma: A short review of practice

Author(s): Kirit Singh, Avinash Kumar Kanodia*, Mahmoud H Kamel, Peter Ross and Kismet Hossain-Ibrahim

Skull base meningiomas are typically slow growing and often present late only once they begin to compress nearby neurovascular structures. While craniotomy has been the mainstay of treatment in the past, endoscopic endonasal trans-sphenoidal (EET) techniques are increasingly favoured due to being less invasive with fewer complications. This short review analyses the experience of two neurosurgical centres using an endoscopic approach to solely decompress the optic apparatus where complete meningioma resection was considered too great a risk. Cases were retrospectively analysed from electronic medical and operative records from June 2008 to December 2017. Patients were selected if they had undergone EET surgery to debulk a meningioma causing deterioration of their vision but were deemed unsuitable for total resection due to tumour size or the relationship with surrounding neurovascular structures. 196 patients underwent endoscopic transsphenoidal surgery primarily for pituitary tumours in this 114-month period. Of these cases, 4 patients underwent EET surgery solely to debulk a meningioma compressing their optic apparatus (M=3, F=1) with a median age of 56.5 years (range 53-69 years). Half reported some improvement in their visual field perception, while one case reported a benefit in both visual fields and acuity. None of the cases described any post-operative deterioration in their sight. This short review of cases demonstrates our experience of the safety and efficacy of an EET approach for decompression of the optic nerve and chiasm. This supports its ongoing use in the protection of key neurovascular structures at risk of compromise by an expanding skull base meningioma.


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