Oh, the joys of modern neurosurgery, where we boldly go where no one has gone before… through the nose. Yes, you heard it right. When it comes to the daunting task of removing ventral and ventrolateral meningiomas from the posterior cranial fossa, some bright minds thought, “Why not take the scenic route?” And thus, the endoscopic transnasal approach was born, a technique that’s as popular as pineapple on pizza in the neurosurgical world.

So, we decided to take a deep dive into the vast ocean of world literature, which, in this case, turned out to be more of a kiddie pool with 22 articles representing the whopping total of 61 patients. The results? Well, let’s just say they’re a mixed bag. Total or near-total resection, the neurosurgical equivalent of hitting a home run, was achieved in a staggering 22.9% of cases. Subtotal resection, which is kind of like getting to third base, was achieved in 40.9% of cases. And partial resection, essentially making it to first base, was seen in 26.2% of cases. As for the rest, well, they didn’t even get to play the game.

But here’s the kicker: even just getting to first base with these tumors can lead to significant regression of symptoms. That’s right, folks. It turns out that playing it safe and just going for a little off the top can still make a world of difference to patients. Who knew?

In conclusion, the endoscopic transnasal approach to clival meningiomas is not just a fancy party trick but a full-fledged alternative to the good old transcranial methods. And for those petroclival meningiomas that just won’t take the hint after a transcranial approach, it’s like saying, “Don’t worry, we’ve got another way in.” So, next time you think about brain surgery, remember: sometimes, the best approach is right under your nose.