The endoscopic endonasal approach or microscopic transcranial approach for anterior skull base meningiomas—It is all about right indication rather than superiority
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We have read the review article entitled “The endoscopic endonasal approach is not superior to the microscopic transcranial approach for anterior skull base meningiomas—a meta-analysis” by Ivo S. Muskens et al, published in Acta Neurochirugica (2018) 160:59–75 . We want to congratulate the authors for their efforts in taking on this polemic topic and offer some observations.
The authors conducted a systematic review and meta-analysis of the literature from 2004 to 2016 comparing outcomes between an endonasal transsphenoidal approach (eTSA) and a microsurgical transcranial approach (mTCA) for tuberculum sellae meningiomas (TSMs) and olfactory groove meningiomas (OGMs). Outcome variables included gross total resection (GTR), visual improvement, cerebrospinal fluid (CSF) leak, intraoperative arterial injury, and mortality.
Of 1648 studies, they reported that the CSF leak was significantly higher among eTSA patients for both OGM and TSM (eTSA 25.1% vs. mTCA 10.5%, p...
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