Skip to main content

Advertisement

SpringerLink
Log in

The anterior interhemispheric approach - a safe and effective approach to anterior skull base lesions

  • Clinical Article - Neurosurgical Techniques
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Background

Many approaches to the anterior skull base have been reported. Frequently used are the pterional, the unilateral or bilateral frontobasal, the supraorbital and the frontolateral approach. Recently, endoscopic transnasal approaches have become more popular. The benefits of each approach has to be weighted against its complications and limitations. The aim of this study was to investigate if the anterior interhemispheric approach (AIA) could be a safe and effective alternative approach to tumorous and non-tumorous lesions of the anterior skull base.

Methods

We screened the operative records of all patients with an anterior skull base lesion undergoing transcranial surgery. We have used the AIA in 61 patients. These were exclusively patients with either olfactory groove meningioma (OGM) (n = 43), ethmoidal dural arteriovenous fistula (dAVF) ( n = 6) or frontobasal fractures of the anterior midline with cerebrospinal fluid (CSF) leakage ( n = 12). Patient records were evaluated concerning accessibility of the lesion, realization of surgical aims (complete tumor removal, dAVF obliteration, closure of the dural tear), and approach related complications.

Results

The use of the AIA exclusively in OGMs, ethmoidal dAVFs and midline frontobasal fractures indicated that we considered lateralized frontobasal lesions not suitable to be treated successfully. If restricted to these three pathologies, the AIA is highly effective and safe. The surgical aim (complete tumor removal, complete dAVF occlusion, no rhinorrhea) was achieved in all patients. The complication rate was 11.5 % (wound infection (n = 2; 3.2 %), contusion of the genu of the corpus callosum, subdural hygroma, epileptic seizure, anosmia and asymptomatic bleed into the tumor cavity (n = 1 each). Only the contusion of the corpus callosum was directly related to the approach (1.6 %). Olfaction, if present before surgery, was preserved in all patients, except one (1.6 %).

Conclusions

The AIA is an effective and a safe approach to tumorous, vascular and traumatic pathologies of the midline anterior skull base. This approach should be part of the armamentarium of skull base surgeons.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Abrahams JM, Bagley LJ, Flamm ES, Hurst RW, Sinson GP (2002) Alternative management considerations for ethmoidal dural arteriovenous fistulas. Surg Neurol 58:410–416

    Article  PubMed  Google Scholar 

  2. Agid R, TerBrugge K, Rodesch G, Andersson T, Söderman M (2009) Management strategies for anterior cranial fossa (ethmoidal) dural arteriovenous fistulas with an emphasis on endovascular treatment. J Neurosurg 110:79–84

    Article  PubMed  Google Scholar 

  3. Bassiouni H, Asgari S, Stolke D (2007) Olfactory groove meningiomas: functional outcome in a series treated microsurgically. Acta Neurochir (Wien) 149:109–121

    Article  CAS  Google Scholar 

  4. Boari N, Gagliardi F, Roberti F, Barzaghi LR, Caputy AJ, Mortini P (2013) The trans-fronta-sinus subcranial approach for removal of large olfactory groove meningiomas: sirgical technique and comparison to other approaches. J Neurol Surg A 74:152–161

    Google Scholar 

  5. Cappabianca P, Kelly DF, Laws ER Jr (2008) Endoscopic transnasal versus open transcranial base surgery: The need for a serene assessment. Neurosurgery 63(S4 Suppl 2):240–241

    Article  PubMed  Google Scholar 

  6. Ciurea AV, Iencean SM, Rizea RE, Brehar FM (2012) Olfactory groove meningiomas: a retrospective study on 59 surgical cases. Neurosurg Rev 35:195–202

    Article  PubMed  Google Scholar 

  7. Curey S, Derrey S, Hannequin P, Hannequin D, Fréger P, Muraine M, Castel H, Proust F (2012) Validation of the superior interhemispheric approach for tuberculum sellae meningioma: clinical article. J Neurosurg 117:1013–1021

    Article  PubMed  Google Scholar 

  8. de Divitiis E, Esposito F, Cappabianca P, Cavallo LM, de Divitiis O, Esposito I (2008) Endoscopic transnasal resection of anterior cranial fossa meningiomas. Neurosurg Focus 25:E8

    Article  PubMed  Google Scholar 

  9. El-Bahy K (2009) Validity of the frontolateral approach as a minimally invasive corridor for olfactory groove meningiomas. Acta Neurochir (Wien) 151:1197–1205

    Article  Google Scholar 

  10. Fernandez-Miranda JC, Gardner PA, Prevedello DM, Kassam AB (2009) Expanded endonasal approach for olfactory groove meningioma. Acta Neurochir (Wien) 151:287–288

    Article  CAS  Google Scholar 

  11. Gardner PA, Kassam AB, Thomas A, Snyderman CH, Carrau RL, Mintz AH, Prevedello DM (2008) Endoscopic endonasal resection of anterior cranial base meningiomas. Neurosurgery 63:36–52

    Article  PubMed  Google Scholar 

  12. Gazzeri R, Galarza M, Gazzeri G (2008) Giant olfactory groove meningioma: ophthalmological and cognitive outcome after bifrontal microsurgical approach. Acta Neurochir (Wien) 150:1117–1125

    Article  Google Scholar 

  13. Halbach VV, Higashida RT, Hieshima GB, Wilson CB (1990) Dural arteriovenous fistulas supplied by ethmoidal arteries. Neurosurgery 26:816–823

    Article  CAS  PubMed  Google Scholar 

  14. Hassler W, Zentner J (1991) Surgical treatment of olfactory groove meningiomas using the pterional approach. Acta Neurochir Suppl (Wien) 53:14–18

    Article  CAS  Google Scholar 

  15. Hori T, Kawamata T, Amano K, Aihara Y, Ono M, Miki N (2010) Anterior interhemispheric approach for 100 tumors in and around the anterior third ventricle. Neurosurgery 66(3 Suppl Operative):65–74

    PubMed  Google Scholar 

  16. Kakarla UK, Deshmukh VR, Zabramski JM, Albuquerque FC, Dougall CG, Spetzler RF (2007) Surgical treatment of high-risk intracranial dural arteriovenous fistulae: Clinical outcomes and avoidance of complications. Neurosurgery 61:447–459

    Article  PubMed  Google Scholar 

  17. Kassam AB, Thomas A, Carrau RL, Snyderman CH, Vescan A, Prevedello D, Mintz A, Gardner P (2008) Endoscopic reconstruction of the cranial base using a pedicled nasoseptal flap. Neurosurgery 63:ONS44–ONS52

    Article  PubMed  Google Scholar 

  18. Kim YH, Han DH, Park CK, Lee CH, Kim DG (2011) An endoscopic endonasal transethmoidal approach to olfactory groove meningioma. Cent Eur Neurosurg 72:205–208

    Article  CAS  PubMed  Google Scholar 

  19. Komotar RJ, Starke RM, Raper DM, Anand VK, Schwartz TH (2012) Endoscopic endonasal versus open transcranial resection of anterior midline skull base meningiomas. World Neurosurg 77:713–724

    Article  PubMed  Google Scholar 

  20. Komotar RJ, Starke RM, Raper DM, Anand VK, Schwartz T (2013) Endoscopic endonasal versus open repeir of anterior skull base CSF leak, meningocele, and encephalocele: a systematic review of outcomes. J Neurol Surg A 74:239–250

    Article  Google Scholar 

  21. Kubota M, Saeki N, Yamaura A, Ono J, Ozawa Y (2001) Influences of venous involvement on postoperative brain damage following the anterior interhemispheric approach. Acta Neurochir (Wien) 143:321–325

    Article  CAS  Google Scholar 

  22. Lawton MT, Chun J, Wilson CB, Halbach VV (1999) Ethmoidal dural arteriovenous fistulae: An assessment of surgical and endovascular management. Neurosurgery 45:805–813

    Article  CAS  PubMed  Google Scholar 

  23. Lee JY, Barroeta JE, Newman JG, Chiu AG, Venneti S, Grady MS (2013) Endsocopic endonasal resection of anterior skull base meningiomas and mucosa: implications for resection, reconstruction, and recurrence. J Neurol Surg 74:12–17

    Google Scholar 

  24. Lévêque S, Derrey S, Martinaud O, Géradin E, Langlois O, Fréger P, Hannequin D, Castel H, Proust F (2011) Superior interhemispheric appraoch for midline meningioma from the anterior cranial base. Neurochirurgie 57:105–113

    Article  PubMed  Google Scholar 

  25. Lv X, Li Y, Wu Z (2008) Endovascular treatment of anterior cranial fossa dural arteriovenous fistula. Neuroradiology 50:433–437

    Article  PubMed  Google Scholar 

  26. Mayfrank L, Gilsbach JM (1996) Interhemispheric approach for microsurgical removal of olfactory groove meningiomas. Br J Neurosurg 10:541–545

    Article  CAS  PubMed  Google Scholar 

  27. Mayfrank L, Reul J, Huffmann B, Bertalanffy H, Spetzger U, Gilsbach JM (1996) Microsurgical interhemispheric appraoch to dural arteriovenous fistulas of the floor of the anterior cranial fossa. Minim Invasive Neurosurg 39:74–77

    Article  CAS  PubMed  Google Scholar 

  28. Munich SA, Fenstermaker RA, Fabiano AJ, Rigual NR (2013) Cranial base repair with combined vascularized nasal septal flap and autologous tissue graft following expanded endonasal endoscopic neurosurgery. J Neurol Surg A 74:101–108

    Article  Google Scholar 

  29. Nakamura M, Struck M, Roser F, Vorkapic P, Samii M (2007) Olfactory groove meningiomas: clinical outcome and recurrence rates after tumor removal through the frontolateral and bifrontal approach. Neurosurgery 60:844–852

    Article  PubMed  Google Scholar 

  30. Padhye V, Naidoo Y, Alexander H, Floreani S, Robinson S, Santoreneos S, Wickremesekera A, Brophy B, Harding M, Vrodos N, Wormald PJ (2012) Endoscopic endonasal resection of anterior skull base meningiomas. Otolaryngol Head Neck Surg 147:575–582

    Article  PubMed  Google Scholar 

  31. Piipp A, Niemelä M, van Popta J, Kangasniemi M, Rinne J, Jääskeläinen JE, Hernesniemi J (2013) Characteristics and long-term outcome of 251 patients with dural arteriovenous fistulas in a defined population. J Neurosurg 118:923–934

    Article  Google Scholar 

  32. Romani R, Lehecka M, Gaal E, Toninelli S, Celik O, Niemelä M, Porras M, Jääskeläinen J, Hernesniemi J (2009) Lateral supraorbital approach applied to olfactory groove meningiomas: experience with 66 consecutive patients. Neurosurgery 65:39–52

    Article  PubMed  Google Scholar 

  33. Scholsem M, Scholtes F, Collignon F, Robe P, Dubuisson A, Kaschten B, Lenelle J, Martin D (2008) Surgical management of anterior cranial base fractures with cerebrospinal fluid fistulae: a single-institution experience. Neurosurgery 62:463–469

    Article  PubMed  Google Scholar 

  34. Singh V, Smith WS, Lawton MS, Halbach VV, Young WL (2008) Risk factors for hemorrhagic presentation in patients with dural arteriovenous fistulae. Neurosurgery 62:628–625

    Article  PubMed  Google Scholar 

  35. Spektor S, Valarezo J, Fliss DM, Gil Z, Cohen J, Goldman J, Umansky F (2005) Olfactory groove meningiomas from neurosurgical and ear, nose, and throat perspectives: approaches, techniques, and outcomes. Neurosurgery 57:268–280

    Article  PubMed  Google Scholar 

  36. Telera S, Carapella CM, Caroli F, Crispo F, Cristalli G, Raus L, Sperduti I, Pompili A (2012) Supraorbital keyhole appraoch for removal of midline anterior cranial fossa meningiomas: a series of 20 consecutive cases. Neurosurg Rev 35:67–83

    Article  PubMed  Google Scholar 

  37. Terasaka S, Asaoka K, Kobayashi H, Yamaguchi S (2011) Anterior interhemispheric approach for tuberculum sellae meningioma. Neurosurgery 68(1 Suppl Operative):84–88

    PubMed  Google Scholar 

  38. Tomasello F, Angileri FF, Grasso G, Granata F, De Ponte FS, Alafaci C (2011) Giant olfactory groove meningiomas: extent of frontal lobes damage and long-term outcome after the pterional approach. World Neurosurg 76:311–317

    Article  PubMed  Google Scholar 

  39. Turazzi S, Cristofori L, Gambin R, Bricolo A (1999) The pterional approach for the microsurgical removal of olfactory groove meningiomas. Neurosurgery 45:821–825

    Article  CAS  PubMed  Google Scholar 

  40. van Dijk JMC, Terbrugge KG, Willinsky RA, Wallace MC (2004) Selective disconnection of cortical venous reflux as treatment for cranial dural arteriovenous fistulas. J Neurosurg 101:31–35

    Article  PubMed  Google Scholar 

  41. Wachter D, Hans F, Psychogios MN, Knauth M, Rohde V (2011) Microsurgery can cure most intracranial dural arteriovenous fistulae of the sinus and non-sinus type. Neurosurg Rev 34:337–345

    Article  PubMed Central  PubMed  Google Scholar 

  42. Webb-Myers R, Wormald PJ, Brophy B (2008) An endoscopic endonasal technique for resection of olfactory groove meningioma. J Clin Neurosci 15:451–455

    Article  CAS  PubMed  Google Scholar 

  43. White DV, Sincoff EH, Abdulrauf SI (2005) Anterior ethmoidal artery: microsurgical anatomy and technical considerations. Neurosurgery 56(Suppl 2):ONS406–ONS410

    Article  Google Scholar 

Download references

Conflict of Interest

None.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Georg-August-University Göttingen, Robert-Koch-Strasse 40, 37075, Göttingen, Germany

    Dorothee Mielke & Veit Rohde

  2. Department of Neurosurgery, University of Technology (RWTH) Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany

    Lothar Mayfrank & Veit Rohde

  3. Department of Neuroradiology, Georg-August-University Göttingen, Robert-Koch-Strasse 40, 37075, Göttingen, Germany

    Marios Nikos Psychogios

  4. Neuro Clinic Stuttgart, Eierstrasse 46, 70199, Stuttgart, Germany

    Lothar Mayfrank

  5. Neurochirurgische Klinik, Georg-August-Universität Göttingen, Robert-Koch-Strasse 40, D-37075, Göttingen, Germany

    Dorothee Mielke

Authors
  1. Dorothee Mielke
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lothar Mayfrank
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marios Nikos Psychogios
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Veit Rohde
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Dorothee Mielke.

Additional information

Clinical Trial Registration: not applicable

Rights and permissions

Reprints and permissions

About this article

Cite this article

Mielke, D., Mayfrank, L., Psychogios, M.N. et al. The anterior interhemispheric approach - a safe and effective approach to anterior skull base lesions. Acta Neurochir 156, 689–696 (2014). https://doi.org/10.1007/s00701-013-1972-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-013-1972-x

Keywords

Search

Navigation