Optimizing Surgical Access to Anterior Basal Meningiomas: A Comparative Evaluation of Approaches

Background: Anterior basal meningiomas, extending from the crista galli to the tuberculum sellae, pose unique surgical challenges due to their deep-seated location and proximity to critical neurovascular structures. Various approaches have been developed to access these tumors, including pterional, bi-frontal trans-basal, eyebrow, and trans-nasal techniques. This study aims to evaluate the feasibility, safety, and surgical outcomes associated with the fronto-lateral approach compared to other established routes. Methods: A prospective observational study was conducted on 45 patients diagnosed with anterior basal meningiomas. Surgical approaches employed included fronto-lateral, pterional, eyebrow, and bi-frontal trans-basal techniques. Intraoperative and postoperative parameters assessed included brain retraction, cisternal opening, CSF aspiration, optic canal decompression, nerve decompression, operative duration, blood loss, bone removal, and complications such as CSF leakage, cranial nerve palsy, and muscle atrophy. Results: Patients were followed for a mean duration of 2.8 years. Olfactory groove meningiomas accounted for 35.5% of cases, while tuberculum sellae meningiomas represented 46.6%, with headache and visual impairment being the predominant symptoms. Gross total resection was achieved in 95% of patients. The fronto-lateral approach demonstrated the shortest operative time (P = 0.00001), limited brain retraction, early CSF release, reduced intraoperative bleeding, less extensive bone work, and superior preservation of neural structures. Conclusion: The fronto-lateral (lateral supraorbital) approach emerges as a safe and efficient option for anterior basal meningiomas, aligning with principles of minimal invasiveness and surgical precision. The adjunctive use of papaverine-infused saline and early optic canal decompression has shown promise in enhancing visual outcomes in patients presenting with preoperative visual deficits. Publication History Article published online: 27 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany