Comparative Efficacy of Endoscopic Endonasal versus Transcranial Approaches for Treating Olfactory Groove Meningiomas: A Systematic Review and Meta-Analysis.

Abstract

The optimal surgical approach for olfactory groove meningiomas (OGMs) remains debated. Comparisons between the endoscopic endonasal approach (EEA) and transcranial approach (TCA) are limited by confounding by indication, as tumor anatomy dictates approach selection. This meta-analysis synthesizes evidence while addressing these limitations. A systematic review and meta-analysis were conducted following PRISMA guidelines. PubMed, Embase, Web of Science, Scopus, and Cochrane Library were searched (2000-2024). Studies reporting EEA and TCA outcomes were included. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using a random-effects model, with heterogeneity assessed using I². Outcomes included gross total resection (GTR), visual outcomes, CSF leak, complications, and recurrence. Eight studies (n = 382) were included. Pooled analysis of 3 comparative studies showed no significant difference in GTR (OR: 0.71, 95% CI: 0.23-2.19, I² = 0%) or recurrence (OR: 1.63, 95% CI: 0.60-4.45, I² = 0%). EEA was associated with higher odds of CSF leak (OR: 5.36, 95% CI 1.64-17.5, I² = 0%). GTR rates ranged from 82%-96% for EEA and 86%-100% for TCA, while CSF leak rates were 16%-30% and 2%-7%, respectively. Visual outcomes were comparable or favored EEA. EEA was mainly used for smaller tumors, while TCA was used for larger lesions. Both approaches are effective, but comparisons are limited by selection bias. EEA carries a higher CSF leak risk, while GTR and recurrence are comparable. TCA achieves more consistent GTR in complex tumors. Approach selection should be individualized based on tumor anatomy and surgeon expertise.