Total resection of recurrent meningothelial meningioma through a combined transcranial.endonasal approach

Objective: To evaluate the efficacy of combining an endonasal endoscopic approach and transcranial approach in a patient with a recurrent olfactory cleft meningothelial meningioma. Case report: A 57-years-old female caucasian patient was referred to our institution with a previous history hypertension and a right frontal craniotomy for a World Health Organization (WHO) grade I meningioma with 70% removal of the lesion. A second frontal craniotomy was performed with a 95% resection of the tumor. She received adjuvant treatment with Conformal Radiotherapy (30 sessions) and Nimotuzumab (33 doses). Seven months after was treated surgically for a bone flap osteomyelitis with removal of the bone flap. An endonasal endoscopic transcribiform approach was performed with a partial removal of the lesion. Few weeks after the patient started again with frontobasal soft tissue growing and frontal headache. CT and RMI scans showed regrowing of the tumor. A combined simultaneous endonasal endoscopic approach-transcraneal approach through bilateral frontal craniotomy was performed. There were not transoperative or postoperative complications. The hospital stay was 9 days. Conclusions: Olfactory groove meningiomas can extend into the paranasal sinuses. The cranial base and paranasal sinuses are the most common sites of tumor recurrence even after gross total resection. Radical tumor resection, by a combined endonasal and transcranial approach is the best way to reduce the chances of recurrence.