The outcome of bilateral subfrontal approach of large olfactory groove meningioma

Abstract

Objective The aim of the study was to evaluate the value of bilateral subfrontal approach for management of olfactory groove meningioma focused on preoperative and postoperative investigations for ophthalmologic disturbance. Background Olfactory groove meningiomas arise in the midline along the dura of the cribriform plate and may reach a large size before producing symptoms. There are many surgical approaches such as bilateral subfrontal, unilateral subfrontal, and pterional approaches for this lesion. Patients and methods Over a 3-year period, 20 patients with olfactory groove meningiomas more than 4.5 cm in diameter were operated upon using the bilateral subfrontal approach. Data related to clinical history, symptoms, signs, and outcome were obtained by review of the patient's clinical notes, operative reports, histopathological records, follow-up records, and radiological images. Operative and postoperative events were noted with a follow-up period of 6 months. Results Twenty patients with olfactory groove meningiomas were approached by bilateral subfrontal approach. The most common presenting symptom was headache, which was seen in 16 patients (80%). On admission, five patients (25%) had mental status changes, nine patients (45%) presented with associated visual complaints, and two patients (20%) had epilepsy at presentation. Within the first month after surgery, the postoperative visual acuity was improved in two patients, whereas in seven patients it remained unchanged. In two patients, visual field defects improved and in one patient the defects resolved completely. Conclusion Visual deficits can be improved in patients with olfactory groove meningiomas after a bifrontal approach, after 6 months follow-up period without additional neurological deficits.