ИСТИНА

OBJECTIVE. To analyze the prognostic factors and develop recommendations for optimal management of midline anterior skull base meningiomas with intra- and extracranial extension. The analysis is based on a large single-center series (125 surgically treated patients). MATERIALS AND METHODS. The non-randomized cohort study included a total of 125 observations of 89 female and 36 male surgically treated patients. The mean age was 50 years (8 – 78 years). Measures of outcomes included early postoperative results (improvement, unchanged, worsening, fatal outcome) and morbidity, and long-term results (tumor control, progression, fatal outcome) and complications, overall and progression-free survival. All tumors were divided into three groups: 1) with predominantly intracranial extension, 2) with predominantly extracranial extension, 3) with significant intra- and extracranial extension. RESULTS. Gross total resection was achieved in 34 cases (27.2%), incomplete in 91 (72.8%), including resection of intracranial portion in 29 (23.2%), extracranial – in 48 (38.4%), and intra- and extracranial – in 14 (11.2%). Early postoperative mortality was 0.8%, morbidity was 25.6%. Follow-up data were available in 90 patients (72%). Tumor control was achieved in 59 patients (65.6%), progression occurred in 21 (23.3%), and ten patients died (11.1%), including five mortalities related to the tumor progression or complications. Delayed complications were observed in 15 patients (16.7%). We determined the prognostic factors of outcomes and proposed management algorithms. CONCLUSION. To avoid severe progression, such pure intracranial tumors as olfactory groove, or planum, or tuberculum sellae should be resected completely. Midline craniofacial meningiomas also demand gross total resection, otherwise adjuvant radiation treatment is required. Resection via transsinusal frontal approach is the treatment of choice due to better control of tumor margins and visualization of skull base defect. Endoscopic endonasal or combined approaches have completely replaced facial incisions. Optic canal decompression is reasonable for regression of visual disturbances at reversible stage.