Effectiveness of the Extended Transsphenoidal Approach for Anterior Skull Base Meningiomas: A Systematic Review and Meta-analysis

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Purpose: Anterior skull base meningiomas can lead to significant symptoms, including mass effect and neuropsychological decline, necessitating surgical resection. The endoscopic extended transnasal approach has emerged as a minimally invasive alternative to craniotomy, offering a means to address these tumors despite challenges posed by the proximity of critical neurovascular structures and the risk of complications such as CSF leaks. This systematic review and meta-analysis evaluate the safety and efficacy of extended transsphenoidal techniques in anterior skull base meningiomas. Methods: Following PRISMA guidelines and the Cochrane Handbook, a search was conducted in Medline, Embase, Cochrane, and Ovid. Eligible studies included those in English, with patients having anterior skull base meningiomas, and who underwent endoscopic surgical management. Endpoints included CSF leak, length of stay, complications, and mortality. Major complications were permanent, while minor complications were transient. Tumor-related mortality encompassed any mortality due to tumor presentation, procedure, subsequent treatment, and postoperative course. Results: The analysis included data from 28 studies with a total of 725 patients, having a median age of 54.77 years, and approximately 71% of them were female. The incidence of CSF leaks was 9% (95% CI: 0.06–0.12) ([ Fig. 1 ]), the overall complication rate was 6% (95% CI: 0.00–0.13) ([ Fig. 2 ]), major complications were noted in 21% of cases (95% CI: 0.12–0.30) ([ Fig. 3 ]), and minor complications showed a rate of 6% (95% CI: 0.00–0.13) ([ Fig. 4 ]). Fig. 1 CSF leak rates. Fig. 2 Overall complications. Fig. 3 Major postoperative complications. Fig. 4: Minor postoperative complications. Conclusion: Despite the complex anatomical challenges and inherent risks, the extended transsphenoidal approach demonstrated a relatively low complication rate and an acceptable length of hospital stay. This method showed significantly lower CSF leak and complication rates compared to previously published studies from the last decade. Publication History Article published online: 07 February 2025 © 2025. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

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