Objective: The complete resection of anterior cranial base meningiomas with intra- and extracranial involvement is always challenging. We describe our experience of treating such meningiomas via a purely endoscopic endonasal approach (EEA). Methods: Eight patients with intra- and extradural meningiomas were operated via EEA. In this study, we describe the operative technique, and analyze the degree of resection, complications and the clinical outcomes. Results: The complete resection of meningiomas with intra- and extracranial involvement was achieved in all patients using EEA. Preoperative visual symptoms were improved or resolved in all cases. One patient experienced a postoperative cerebrospinal fluid leak and delayed meningitis. No patient in our series experienced a new neurological deficit after surgery or recurrence in the follow-up period (18–60 months). Conclusion: Our limited experience indicates that EEA is feasible and safe for the complete resection of anterior cranial base meningiomas with intra- and extracranial involvement in one stage in selected cases.

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