A Multi-institutional Comparison of Transcranial vs Endonasal Approaches for Planum / Tuberculum Sella Meningiomas
Ricardo Komotar, Juan Fernandez-Miranda, Eric Wang, Ezequiel Goldschmidt, Stephanie Chen, Paul Gardner, Carl Snyderman, Michael Ivan , Hanna Algattas, Georgios Zenonos, Jacques Morcos, Samir Sur, Rachel Jacobs
Introduction: There remains significant debate regarding the optimal management of planum (P) and tuberculum sella (TS) meningiomas.
Objective: We sought to evaluate the surgical outcomes from two institutions with polarized preferences and extended experience in endoscopic endonasal (EEA) and transcranial approaches (TC).
Methods: We performed a retrospective review of 54 patients who underwent TC resection and 30 patients who underwent EEA at two high volume academic centers between 2012 and 2018. Using a multivariate logistic regression analysis, we compared patient demographics, tumor characteristics, and surgical outcomes between the 2 cohorts.
Results: Total 84 patients, average age 56.3 years, female (78.5%). There were no significant differences between the EEA and TC cohort in presentation, prior surgery or radiation, or comorbidities. Mean tumor volume was significantly higher in the TC compared to EEA group (13.3 ml versus 5.6 ml, p=0.012). During a similar follow-up period (16.5 months TC, and 16.8 months for EEA, P=0.9),76% of patients were free of disease after TC and 67% after EEA (p=0.362). EEA was a significant predictor of improved visual outcomes postop (OR 6.4, 95% CI 1.810-22.803, p=0.004) whereas neither approach was associated with worse visual outcomes after surgery. Rates of postoperative hematoma requiring surgical intervention was significantly higher in the EEA cohort (10% versus 0%, p=0.018) as well as mean length of surgery (6.31 hrs versus 4.88 hr, p=0.007). There were no significant differences in length of stay, CSF leak, meningitis, or postop MRI flair changes.
Conclusions: In our study, overall outcomes after endoscopic or transcranial approaches in experienced hands were very similar. The choice of approach may be dictated by both tumor characteristics and surgeon comfort level. Extended follow-up to uncover possible differences in recurrence rates are desirable.