Comparative Analysis of Endoscopic Transorbital Approach and Extended Mini-Pterional Approach for Sphenoid Wing Meningiomas with Osseous Involvement: Preliminary Surgical Results

Abstract Objective Sphenoid wing meningiomas (SWMs) can be treated with complete surgical resection and recent endoscopic transorbital approach (ETOA) offers one of minimally invasive alternatives. The authors compare the surgical outcome of ETOA and extended mini-pterional approach (eMPTA) for SWMs with osseous involvement. Methods From October 2015 to May 2019, a total of 24 patients underwent surgery for SWMs with osseous involvement. Among them, tumor resection was performed by ETOA for 11 patients (45.8%) and eMPTA for 13 patients (54.2%). The tumor characteristics, surgical outcome and morbidity, and approach-related aesthetic outcome were analyzed and compared retrospectively between ETOA and eMPTA based on SWM classification. Results The location of SWMs was mostly middle sphenoid ridge (group III) (45.8%), followed by greater sphenoid wing (group IV) (29.2%). Simpson resection grades I/II were achieved in 9 of 11 patients (81.8%) with ETOA and 11 of 13 patients (84.6%) with eMPTA. There were no differences in tumor characteristics between the two approaches. Surgery time, surgical bleeding, and hospital length of stay were significantly shorter with ETOA. Three patients had transient surgical morbidities such as diplopia (n=1), ptosis (n=1), and cerebrospinal fluid leak (n=1) after ETOA. No differences could be seen in surgical morbidities between ETOA and eMPTA. Conclusions ETOA can provide direct access to the sphenoid bone and resectability with a more rapid and minimally invasive exposure than eMPTA. Maximal subtotal resection with extensive sphenoid bone decompression for tumors with CS infiltration is the key to a good clinical outcome, regardless of the surgical approach.