Meningiomas of the anterior skull base include those arising from the olfactory groove, planum sphenoidale and tuberculum sellae. Decisions on how to best manage these tumors, whether from a transcranial or expanded endoscopic endonasal approach (EEA), remain challenging and as such have generated significant attention and study. Over the past 20 years, there has been greater uptake of the EEA in carefully selected patients with anterior skull base meningiomas as compared to a transcranial approach. This is attributed to various factors, such as the avoidance of extensive bone drilling or brain retraction and the ability to directly access the base of these tumors for early devascularization and optic nerve decompression with the EEA. ^{Reference Komotar, Starke, Raper, Anand and Schwartz1–Reference Magill, Schwartz and Couldwell3} Improved reconstruction methods for the anterior skull base through EEA, largely from adaptations of the pedicled nasoseptal flap, have been important in reducing the rates of cerebrospinal fluid leakage, which remains the most common complication from endonasal surgery. ^{Reference Komotar, Starke, Raper, Anand and Schwartz1,Reference Magill, Schwartz and Couldwell3}

This paper by Vargas-Moreno and colleagues ^{Reference Vargas-Moerno, Khairy and Saymeh4} highlights the merits of the endoscopic endonasal approach for resection of anterior skull base meningiomas, namely those of the olfactory groove and tuberculum sellae. Clinical outcomes compiled over nearly a decade of surgeries at The Ottawa Hospital demonstrate the safety and efficacy of the extended endonasal approach and overall success in achieving gross total or near total removal of tumors of the anterior skull base.

In their retrospective case series of endonasal cases, no worsening vision was reported following resection of tuberculum sellae meningiomas. No CSF leaks occurred from olfactory groove meningioma cases, and four such cases (16%) from tuberculum sellae meningiomas were managed with a period of lumbar drainage, without another endonasal reconstruction. ^{Reference Vargas-Moerno, Khairy and Saymeh4} The rate of CSF leak is similar to larger multi-center retrospective analyses reported recently ^{Reference Magill, Schwartz and Couldwell3} and literature reviews examining the complication rate from experiences 10 to 20 years prior. ^{Reference Komotar, Starke, Raper, Anand and Schwartz1} It would certainly be of value to consider the contemporaneous rates of CSF leaks from the group (over maybe the next 10 years), when reflecting on the greater utilization of, and comfort with, the endoscopic approach, ^{Reference Magill, Schwartz and Couldwell3} together with seemingly improved upon reconstruction techniques.