The Endoscopic L-Shape Approach for Anterior Skull Base Meningiomas with Olfactory Preservation: A Technical Note

Background: The preservation of olfaction during the surgical resection of anterior skull base meningiomas presents a significant challenge. This study presents a modified endonasal endoscopic L-shaped approach designed to maximize tumor resection while preserving olfaction, a vital function that profoundly impacts the quality of life.

Methods: A cadaveric dissection was conducted to refine the surgical technique, and this approach was subsequently applied to a 34-year-old female patient presenting with a large planum sphenoidale meningioma.

Results: Gross total resection was achieved while preserving the patient's left olfactory epithelium and bulb. Olfactory function was assessed 3 months postoperatively using the Smell Diskettes Test, with the patient scoring 5 of 8, indicating hyposmia. Follow-up at 1 year demonstrated preserved olfactory function and no recurrence of the tumor.

Conclusions: The L-shaped modification for endoscopic resection of anterior skull base meningiomas provides effective exposure with the possibility of preserving olfaction. Future studies are needed to validate these outcomes, but careful patient selection and meticulous planning are essential for optimal results.