Endoscopic transnasal suprasellar approach for anterior clinoidal meningioma: A case report and review of the literature

BACKGROUND: Anterior clinoidal meningiomas (ACM) are traditionally approached through transcranial routes. Due to their tendency to extend laterally and their proximity to vital neurovascular structures, the endoscopic transnasal suprasellar approach is still questionable. We present and describe an ACM case that underwent an endoscopic transnasal suprasellar approach, and provide a review of the literature and operative technique. CASE DESCRIPTION: A 56 year-old lady who presented with chronic left-sided decreased vision. Brain imaging revealed a lesion measuring 9 × 10 × 11 mm attached to the left anterior clinoid process (ACP) and extending to the left optic canal. Lesion was compressing the left optic nerve (ON) and abutting the supraclinoid part of the left internal carotid artery (ICA). Utilizing the endoscopic transnasal suprasellar approach, the meningioma was resected and the optic canal was decompressed. Reconstruction was achieved using fascia lata, vomer bone, and nasoseptal flap. A lumbar drain was inserted perioperatively. Patient had no perioperative morbidity and retained vision in the affected eye. CONCLUSIONS: Resection of selected ACMs can be safely achieved utilizing the endoscopic transnasal suprasellar approach. Although the literature lacks long-term outcome comparison between the transnasal and the traditional transcranial approaches, specifically addressing ACMs, this technique is becoming more popular over the last decade. More efforts should be directed towards implementing and reporting the endoscopic transnasal suprasellar approach for meningiomas of the anterior clinoid process.