Anterior basal meningiomas: Can different approaches make a difference?

Background: Anterior basal meningioma extends from the crista galli to the tuberculum sellae. They can be surgically approached through pterional, anterior bi-frontal trans-basal, eyebrow, trans-nasal, and notably through the fronto-lateral approach (FLA). Here, we highlight the feasibility and efficacy of this approach. Methods: A prospective observational study was conducted on 45 patients with anterior basal meningiomas using fronto-lateral, pterional, eyebrow, and bifrontal trans-basal approaches. Key surgical parameters assessed included brain retraction, cisternal opening, cerebrospinal fluid (CSF) aspiration, optic canal de-roofing, nerve decompression, duration, blood loss, bony work, and postoperative complications such as CSF leakage, muscle atrophy, and nerve palsy. Results: The patients were followed for an average of 2.8 years. Olfactory groove meningiomas accounted for 35.5% and tuberculum sellae for 46.6%, with headache and visual loss being common symptoms. Gross total resection was achieved in 95% of cases. The FLA was associated with the shortest operative time ( Conclusion: The fronto-lateral (lateral supra-orbital) approach is the most in line with the principles of simplicity and safety. The use of papaverinated saline combined with early optic canal de-roofing has been associated with significant visual improvement in cases presenting with visual deterioration.