Objective: Olfactory groove meningiomas (OGMs) have largely been addressed through wide surgical exposure techniques including bicoronal or pterional craniotomy. Outcomes comparing these approaches to minimally invasive approaches like the supraorbital craniotomy (SOC) are lacking. Methods: Institutional records were reviewed to include surgically resected OGMs. Variables of interest included tumor volume & height, size of frontal sinus, distance of tumor from posterior table of frontal sinus, surgical approach, extent of resection, recurrence, complications and follow up. Statistical analysis was performed using independent t-test for continuous and Chi-square test for categorical variables. Results: A total of 49 patients were identified. SOC was performed in 17 patients and traditional open approaches were performed in 30 cases. The incidence of complications was 24.5% with CSF leak being the most common. The mean follow up was 35 months. Comparison of SOC with traditional open approaches revealed that tumors in the SOC subgroup had significantly smaller volume (20 cm3 vs 68 cm3; p<0.001), shorter height (2.5 cm vs 3.85 cm; p<0.001) and were more posterior from the frontal sinus as compared to traditional approach (1.5 cm vs 0.85 cm; p=0.003). The length of stay was significantly shorter in SOC subgroup (4.25 days vs 8 days; p=0.02). Conclusion: SOC offers a shorter length of stay as compared to traditional surgical approaches for small to medium sized OGMs with a comparable extent of resection, risk of recurrence and complications. The size of frontal sinus did not appear to be a limiting factor in selecting SOC approach.
Abstract We evaluated presentation, comorbidities, and long-term outcomes of acromegaly at a newly established pituitary center. We conducted a retrospective chart review of patients who underwent surgery by a single skull-based-trained neurosurgeon between July 2018 and February 2024. We compared presentation and comorbidities in two groups of patients: A (postoperative remission) and B (persistent growth hormone [GH] excess). Tertiary referral academic medical center. Of the 50 patients (52% male, mean age at surgery 48.8 ± 15.0 years) with GH-secreting adenoma, 8 (16%) were incidentally detected, and 11 (22%) had prior surgery by another neurosurgeon. Men (vs. women) were older, with more frequent hypopituitarism and vision changes at presentation. Group A (postoperative remission) included 25 patients. Low immediate postoperative GH levels (cutoff 1.705 ng/mL, area under the curve [AUC] 0.81) predicted durable postoperative remission. Mean GH levels were lower in Group A (vs. Group B) throughout the postoperative follow-up period of 39.5 months (12.53, 51.58). Group B had more hyperglycemia (p = 0.04) and overall comorbidities (p = 0.03). Hyperglycemia was significantly associated with lower odds of postoperative remission (odds ratio 0.306, p = 0.043). At last follow-up (median 39.5 months; interquartile range [IQR] 12.53, 51.58), 37/49 (75%) patients attained biochemical control, including 25 in group A and 12 in group B, the latter with additional therapy. Acromegaly can be incidentally detected; hence, insulin-like growth factor-1 (IGF-1) measurement is indicated in all pituitary adenomas. Patients with persistent GH excess postoperatively have a greater long-term burden of comorbidities and require multimodality therapy. Biochemical control is attainable at pituitary centers of expertise with dedicated neurosurgeons and endocrinologists.
Abstract This study aims to describe a posterior endoscopic condyle-sparing approach (PECSA) to the endocranial hypoglossal canal as a minimally invasive posterior skull base corridor that avoids occipital condyle drilling. Descriptive anatomical proof-of-concept study comprising independent radiological trajectory analysis and cadaveric dissection. Academic neurosurgical skull base laboratory. Five randomly selected de-identified clinical computed tomography angiography (CTA)/magnetic resonance imaging (MRI) datasets and two adult formalin-fixed, silicone-injected cadaveric heads. Feasibility was defined as the establishment of a posterior suboccipital endoscopic corridor without occipital condyle resection, with visualization of the hypoglossal nerve and its canalicular entry point. Radiologic planning descriptively identified a posterior midline entry point approximately 2 cm inferior to the inion, projecting to the ipsilateral squamous occipital bone and aligning with the hypoglossal canal while avoiding the brainstem and vertebral artery. The trajectory required approximately 10 to 12 degrees of mediolateral angulation and a steep 50 to 70 degrees craniocaudal bone-incidence angle. Cadaveric dissections confirmed that the corridor could be established without condylar drilling. Endoscopic visualization of the hypoglossal rootlets, hypoglossal nerve, canalicular entry point, vertebral artery, posterior inferior cerebellar artery, and spinal accessory nerve was achieved. Craniotomy-assisted validation confirmed the target anatomy and demonstrated relevant hypoglossal canal variation. PECSA demonstrated preliminary anatomical feasibility as a condyle-sparing route to the endocranial hypoglossal canal. This approach may offer a diagnostic corridor for selected lesions, but further quantitative cadaveric studies, hemostasis, biopsy simulation, and clinical validation are required before patient application.
Abstract The objective of this study is to evaluate vestibular recovery over 36 months following cerebellopontine angle (CPA) meningioma resection and identify clinical and surgical predictors of symptom resolution. This is a retrospective study. Single academic tertiary care medical center. Forty-two patients with CPA meningiomas and preoperative cranial nerve VIII involvement who either presented with vestibular dysfunction or developed new vestibular deficits postoperatively. Vestibular function assessed at baseline and 1, 6, 12, 24, and 36 months, coded as symptomatic or asymptomatic. Logistic regression and Cox proportional hazards modeling controlled for age, sex, tumor volume, presenting symptoms, surgical approach, and extent of resection. Kaplan–Meier analysis compared recovery timing across subgroups. Median age was 54.5 years; median tumor volume was 8.9 cm3. Most tumors were resected via a retrosigmoid approach (83.3%), with gross total resection achieved in 66.7%. Vestibular deficits were present in 92.9% preoperatively and declined to 57.9% in the first postoperative month (p < 0.001). At 36 months, 27.3% remained symptomatic. No consistent predictors of resolution were identified. Recovery was delayed in patients with both hearing and vestibular symptoms compared to those with vestibular-only dysfunction (21.5 vs. 10.5 months; p = 0.047). Among patients with CPA meningiomas and preoperative cranial nerve VIII involvement, most experienced recovery of vestibular function following resection, with improvements continuing through 3 years postoperatively. Recovery was slower in those presenting with both hearing and vestibular symptoms, whereas traditional surgical and anatomical variables were not predictive. These findings may inform patient counseling and guide recovery expectations.
