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<p>Advancements in surgical techniques and technology have led to a proliferation of less-invasive approaches for managing Anterior Skull Base Meningiomas (ASBMs), creating new challenges in selecting the optimal surgical approach. We reviewed the current literature comparing outcomes between Traditional Transcranial Approaches (TCA) and Minimally Invasive Surgical (MIS) techniques. PubMed and Embase databases were searched for studies published up to 18th November 2025. The primary outcome was extent of tumor resection. Secondary outcomes included visual improvement and post-operative complications. Seventeen studies met inclusion criteria. Meta-analysis of Gross Total Resection (GTR) rates for 1740 patients (MIS: 679; TCA: 1061) demonstrated no statistically significant difference between approaches (RR = 1.00, 95% CI 0.94–1.06). Post-operative visual improvement, assessed in 1547 patients (MIS: 601; TCA: 946) showed no statistically significant difference on random-effects modeling, with substantial inter-study heterogeneity (I<sup>2</sup> = 82%). Complication rates across 1746 patients (MIS: 656; TCA: 1090) were higher in MIS on common-effect modeling (RR = 1.22, 95% CI 1.05–1.42), but this difference was not significant on random-effect modeling, again with significant heterogeneity (I<sup>2</sup> = 57%). TCAs remain indispensable, especially for complex or anatomically challenging ASBMs. While MIS approaches offer the advantages of reduced invasiveness, TCAs provide superior intraoperative control, broader exposure, and potentially lower rates of CSF leaks and meningitis. Surgical approach selection should be individualized based on tumor characteristics, surgeon expertise, and patient-specific considerations.</p>

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Revisiting traditional transcranial approaches for anterior skull base meningiomas: a systematic review and meta-analysis of transcranial approaches against minimally invasive surgical techniques

  • 期刊论文

  • 发表日期：

    2025年12月13日

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  • Qingping Joseph Feng,
  • Yilong Zheng,
  • Tristan Kuan Fong Cheong,
  • Peter Ying Khai Hwang

摘要

Advancements in surgical techniques and technology have led to a proliferation of less-invasive approaches for managing Anterior Skull Base Meningiomas (ASBMs), creating new challenges in selecting the optimal surgical approach. We reviewed the current literature comparing outcomes between Traditional Transcranial Approaches (TCA) and Minimally Invasive Surgical (MIS) techniques. PubMed and Embase databases were searched for studies published up to 18th November 2025. The primary outcome was extent of tumor resection. Secondary outcomes included visual improvement and post-operative complications. Seventeen studies met inclusion criteria. Meta-analysis of Gross Total Resection (GTR) rates for 1740 patients (MIS: 679; TCA: 1061) demonstrated no statistically significant difference between approaches (RR = 1.00, 95% CI 0.94–1.06). Post-operative visual improvement, assessed in 1547 patients (MIS: 601; TCA: 946) showed no statistically significant difference on random-effects modeling, with substantial inter-study heterogeneity (I2 = 82%). Complication rates across 1746 patients (MIS: 656; TCA: 1090) were higher in MIS on common-effect modeling (RR = 1.22, 95% CI 1.05–1.42), but this difference was not significant on random-effect modeling, again with significant heterogeneity (I2 = 57%). TCAs remain indispensable, especially for complex or anatomically challenging ASBMs. While MIS approaches offer the advantages of reduced invasiveness, TCAs provide superior intraoperative control, broader exposure, and potentially lower rates of CSF leaks and meningitis. Surgical approach selection should be individualized based on tumor characteristics, surgeon expertise, and patient-specific considerations.