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The Rebirth of Ventral Skull Base Surgery through Multiportal Approaches: Endonasal, Transorbital, Transmaxillary and Transoral Routes

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Dr. Matteo de Notaris

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Guest Editor

Clinic of Neurosurgery, University Hospital San Giovanni di Dio and Ruggi D’Aragona, University of Salerno, 84084 Fisciano, Italy
Interests: skull base surgery; neuroanatomy; neuroendoscopy

Dr. Francesco Corrivetti

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Guest Editor

Department of Neurosurgery, San Luca Hospital, Vallo della Lucania, Salerno, Italy
Interests: skull base surgery; neuroanatomy; neuroendoscopy; functional brain mapping; awake surgery

Special Issue Information

Dear Colleagues,

Skull base tumors represent a constant challenge in our clinical practice. Due to their intrinsic complexity, the state of the art in the management of those pathologies is constantly evolving. The last few decades were marked by remarkable progress in skull base surgery, mostly related to the introduction and refinements of endoscopic techniques, producing a revolution in the surgical management of skull base pathologies. In this scenario, starting from the experience acquired from transsphenoidal surgery together with the constant improvements of anatomical knowledge, it led to the development of several alternative ventral routes to reach the more inaccessible skull base regions. Those ventral skull base routes, such as the transorbital corridors and the transoral–transmaxillary access, were explored to complement the endonasal approach shaping the concept of multiport skull base surgery. The present collection aims to showcase the most recent advancements in this field. This Special Issue focuses on research articles and reviews with a high level of scientific rigor. The topics covered include innovative surgical approaches, challenging surgical indications, technical nuances, emerging technologies, perioperative care, patient outcomes, and complementary treatment in the context of interdisciplinary collaboration. This sum of the research aims to serve as a resource for all the healthcare professionals, researchers, and students interested in the field of cerebrovascular and skull base surgery.

Dr. Matteo de Notaris
Dr. Francesco Corrivetti
Guest Editors

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18 pages, 3943 KiB

Open AccessSystematic Review

Evolution of Surgical Approaches for Trigeminal Schwannomas: A Meta-Regression Analysis from Past to Present

by Edoardo Porto, Giorgio Fiore, Cecilia Casali, Mario Stanziano, Morgan Broggi, Giulio A. Bertani, Hani J. Marcus, Marco Locatelli and Francesco DiMeco

J. Clin. Med. 2025, 14(13), 4488; https://doi.org/10.3390/jcm14134488 - 25 Jun 2025

Viewed by 355

Abstract

Background/Objectives: The surgical management of trigeminal schwannomas (TSs) has evolved considerably, with increasing interest in minimally invasive approaches. We performed a meta-regression analysis to characterise temporal trends in surgical strategies for TS and to explore factors influencing outcomes. Methods: This systematic review and meta-regression followed the PRISMA 2020 guidelines. Comparative studies published in English reporting surgical treatment of TS were included. Outcomes assessed were the extent of resection (EOR), improvement or worsening of trigeminal symptoms, and postoperative complications. Meta-analyses of pooled frequencies were performed, and meta-regression analyses evaluated associations between surgical approach, tumour localization, year of publication, and outcomes. Surgical approaches were categorized as microsurgical antero-lateral (M-AL-Apr), retrosigmoid (RSA), endoscopic endonasal (EEA), and endoscopic transorbital (ETOA). Tumour localization was stratified using the Samii classification. Results: Fifteen studies (583 surgeries) were included. Endoscopic approaches accounted for 20.1% of cases, with increasing use over time (β = 0.12—p < 0.001), largely driven by transorbital access for Samii type A and C tumours. The use of M-AL-Apr declined. The pooled gross-total resection (GTR) rate was 73% (I² = 78.8%). The stratified meta-regression identified a temporal decrease in GTR for Samii type C tumours alone, while resection rates for types A, B, and D remained stable, likely reflecting the increasing proportion of anatomically complex cases in recent series Trigeminal impairment improved postoperatively in 17% (I² = 84.5%), while worsening of trigeminal symptoms was rare (β = 0.07%—I² = 0%). Complication rates were 11.6% (I² = 32.7%) but with a temporal increase (β = 0.041, p = 0.047). Tumour type was the dominant predictor of EOR, functional outcomes, and complications. Conclusions: Surgical management of TS has evolved towards minimally invasive techniques, particularly endoscopic routes, reflecting advances in technology and a focus on functional preservation. Tumour anatomy remains the key determinant of surgical outcomes, highlighting the importance of tailored, anatomy-driven surgical planning. Full article

(This article belongs to the Special Issue The Rebirth of Ventral Skull Base Surgery through Multiportal Approaches: Endonasal, Transorbital, Transmaxillary and Transoral Routes)

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The Rebirth of Ventral Skull Base Surgery through Multiportal Approaches: Endonasal, Transorbital, Transmaxillary and Transoral Routes

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