ORIGINAL ARTICLE - BRAIN TUMORS The expanded endoscopic endonasal approach for suprasellar meningiomas: long-term outcomes in a single-center series of 27 patients Kaiyun Yang 1 & Yosef Ellenbogen 2 & Shaowei Dong 3 & Jeehyun Kim 4 & Ramiro Larrazabal 5 & Amadeo R Rodriguez 6 & Almunder R Algird 1 & Doron D Sommer 4 & Kesava Reddy 1 Received: 21 August 2019 /Accepted: 21 October 2019 # Springer-Verlag GmbH Austria, part of Springer Nature 2019 Abstract Background The endoscopic endonasal approach (EEA) has become increasingly employed in the treatment of suprasellar meningiomas. These tumors often cause visual symptoms due to compression of the anterior visual pathway. We aimed to examine long-term visual outcomes after EEA for optic nerve decompression and resection of suprasellar meningioma at our center, and to identify preoperative factors predictive of postoperative visual improvement. Methods We performed a retrospective cohort study on 27 patients who underwent the EEA for resection of meningiomas extending into the suprasellar cistern and decompression of anterior visual pathway between January 1, 2005, and March 1, 2019. Results We treated 8 male and 19 female patients, with a mean follow-up of 7.6 years. The mean age of our patients at initial presentation was 60.1 years. Eighteen patients (66.7%) are presented with visual acuity deficits, and 12 (44.4%) patients are presented with visual field deficits. Postoperatively, 11 patients had improved visual acuity, 6 had stable visual acuity, and 1 patient had slow and progressive decline of visual acuity; 5 patients had improved visual field, 6 had stable visual field, and 1 patient had slow and progressive decline in visual field. Patients less likely to have postoperative improvement of visual acuity were those with longer than 6-month duration of visual symptoms (P = 0.024*) as well as patients with the presence of a relative afferent pupillary defect (RAPD) (P = 0.023*). Conclusion The EEA can achieve good visual outcomes in patients harboring suprasellar meningiomas. Symptom duration of less than 6 months and lack of a RAPD were positive predictors of postoperative visual acuity. Keywords Anterior skull base meningioma . Endoscopic endonasal surgery . Optic nerve decompression . Suprasellar meningioma . Visual outcome Presentation: This work was presented as a podium presentation on Feb 15, 2019 at the 29th Annual North American Skull Base Society Meeting in Orlando, USA. This work was also presented as a poster on June 19, 2019 at the 54th Annual Canadian Neurological Sciences Federation in Montreal, Canada. This article is part of the Topical Collection on Brain Tumors * Kesava Reddy kesh@keshreddy.ca 1 Division of Neurosurgery, McMaster University, Hamilton, Ontario, Canada 2 Michael DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada 3 Department of Cell and System Biology, University of Toronto, Toronto, Ontario, Canada 4 Division of Otolaryngology and Head and Neck Surgery, McMaster University, Hamilton, Ontario, Canada 5 Division of Neuroradiology, McMaster University, Hamilton, Ontario, Canada 6 Division of Ophthalmology, McMaster University, Hamilton, Ontario, Canada Acta Neurochirurgica https://doi.org/10.1007/s00701-019-04113-x