Giant Olfactory Groove Meningioma Research Articles

Exoscopic resection of giant olfactory groove meningioma.

Olfactory groove meningiomas represent 8%-13% of all intracranial meningiomas. Gross-total resection for large (4-6 cm) and giant (> 6 cm) cases remains challenging due to their relationship with critical neurovascular structures and extensive frontal lobe edema. A variety of transcranial and endoscopic approaches have been described. This 2D operative video shows the use of a digital 3D exoscope in the removal of a giant olfactory groove meningioma through a lateral supraorbital approach in a 57-year-old woman with visual impairment and apathy. The exoscope provides a very good angulated view of the subfrontal area on both sides of the anterior cranial fossa even through a small craniotomy. The video can be found here: https://stream.cadmore.media/r10.3171/2023.10.FOCVID23125.

Outcome of extradural devascularization in resection of giant olfactory groove meningioma in bilateral subfrontal approach

BackgroundOlfactory groove meningioma (OGM) is characterized by slow-growing tumors that are frequently bilateral as opposed to unilateral & asymmetrical and may cause progressive frontal lobe compression. We aimed to evaluate the value of extradural devascularization as a golden step in bilateral subfrontal approach in management of OGM.ResultsThe mean operative time was 158.32 ± 24.88. Blood loss ranged from 500 to 1000 cc with a mean value of 763.64 ± 155.98. The number of patients requiring blood transfusion was 5 (22.7%). Based on Simpson classification, 19 (86.4%) patients had whole tumor excision (grade I, II) & 3 (13.6%) patients had grade III and IV. The incidence of complications among the studied patients is: CSF leak did not occur to any case, pneumocephalus occurred in 1 (4.5%) patient, anosmia occurred in 1 (4.5%) patient, focal CNS deficit occurred in 1 (4.5%) patient, wound infection occurred in 1 (4.5%) patient and hematoma occurred in 1 (4.5%) patient. Only 1 (4.5%) case died due to pulmonary embolism, whereas behavioral manifestations occurred in 9.09% of patients.ConclusionsThe extradural devascularization is a golden step in this approach in management of OGM associated with lower incidence of blood loss intraoperatively (total blood loss was 500–1000 mL, recurrence rate, mortality and additional neurological deficits postoperatively.

In Reply to the Letter to the Editor Regarding “Unilateral Supraorbital Keyhole Craniotomy Avoiding the Frontal Sinus for Large and Giant Olfactory Groove Meningiomas: A Case Series”

In Reply to the Letter to the Editor Regarding “Unilateral Supraorbital Keyhole Craniotomy Avoiding the Frontal Sinus for Large and Giant Olfactory Groove Meningiomas: A Case Series”

Unilateral Supraorbital Keyhole Craniotomy Avoiding the Frontal Sinus for Large and Giant Olfactory-Groove Meningiomas: A Case Series

There are several different approaches to large and giant olfactory-groove meningiomas (OGMs). Each approach has advantages and disadvantages. We present our series using a unilateral supraorbital keyhole approach avoiding the frontal sinus for the resection of large and giant OGMs without the use of fixed brain retractors or orbital rim removal. All consecutive patients operated on for large (>3 cm in largest diameter) and giant (>5 cm) OGMs by the senior author from 2016 to 2021 were prospectively identified and retrospectively reviewed. Patients who were operated on using an endoscopic endonasal approach were excluded. No fixed retraction was used. In total, 14 consecutive patients (11 with large, 3 with giant) were included. All patients were female, with an average age ± standard deviation of 59.7 ± 11.5 years. The median [interquartile range] preoperative Karnofsky Performance Status score was 80 [80-88]. The median preoperative tumor diameter and volume were 3.8 [3.2-4.2] cm and 22.2 [10.5-25.2] cm3, respectively. All patients underwent gross total resection. The median hospital stay was 2.7 [2-3] days, with all patients being discharged to home. No patients incurred any postoperative medical and/or surgical complications. Of the 9 patients who had subjective smell preoperatively, 5 stated they had subjective olfaction after surgery. We demonstrate the utility of a unilateral supraorbital keyhole approach avoiding the frontal sinus for large and giant OGMs. The potential advantages of this approach are minimizing bilateral brain manipulation, avoiding the frontal sinus and potential mucoceles, and reducing the risk of cerebrospinal fluid leaks.

Lateral supraorbital approach for resection of large and giant olfactory groove meningiomas: a single center experience

Background The lateral supraorbital approach (LSO) provides an optimal access corridor for various skull bases lesions, including olfactory groove meningiomas (OGMs). The aim of this study is to describe the authors’ experience with the management of large and giant OGMs utilizing the LSO approach and describe the technical nuances of the procedure. Methods A retrospective review of seven patients with large and giant OGMs managed with the LSO approach between 2013 and 2019 was performed. Radiographic and clinical data were recorded and analyzed. Results Seven patients with large and giant OGMs underwent surgical resection via the LSO approach. Six patients were female, with a median age of 56 years. Patients commonly presented with altered mentation, anosmia, and headaches. The average tumor volume was 120.6 ± 64.7 cm3 with five cases of vascular encasement. Simpson grade II resection was achieved in four patients while Simpson grade IV resection was achieved in three patients. The median length of stay was 2.0 days. The median preoperative Karnofsky Performance Scale (KPS) score was 70, improving to 100 at last postoperative follow-up visit. Two complications were encountered in the form of postoperative cerebrospinal fluid leak in one patient and a transient diplopia in another patient. Tumor recurrence/progression was identified in two patients during a median follow-up time of 65.5 months. Both cases have been managed with adjuvant radiosurgery. Conclusion The LSO approach is a safe and effective minimally invasive transcranial corridor for the management of OGMs that should be part of the armamentarium of skull base neurosurgeons.

Two-step staged resection of giant olfactory groove meningiomas

BackgroundThe surgical treatment of giant olfactory groove meningiomas (OGMs) with marked perilesional brain oedema is still a surgical challenge. After tumour resection, increase of brain oedema may occur causing dramatic neurological deterioration and even death of the patient. The objective of this paper is to describe surgical features of a two-step staged resection of these tumours performed to counter increase of postoperative brain oedema.MethodsThis two-step staged resection procedure was carried out in a consecutive series of 19 patients harbouring giant OGMs. As first step, a bifrontal craniectomy was performed followed by a right-sided interhemispherical approach. About 80% of the tumour mass was resected leaving behind a shell-shaped tumour remnant. In the second step, carried out after the patients’ recovery from the first surgery and decline of oedema, the remaining part of the tumour was removed completely followed by duro- and cranioplasty.ResultsTen patients recovered quickly from first surgery and the second operation was performed after a mean of 12.4 days. In eight patients, the second operation was carried out later between day 25 and 68 due to surgery-related complications, development of a trigeminal zoster, or to a persisting frontal brain oedema. Mean follow-up was 49.3 months and all but one patient had a good outcome regardless of surgery-related complications.ConclusionsOur results suggest that a two-step staged resection of giant OGMs minimizes the increase of postoperative brain oedema as far as possible and translates into lower morbidity and mortality.

The unilateral frontotemporal approach for large and giant olfactory groove meningioma: Experience with 18 consecutive patients

AimAlthough the bifrontal approach used to be recommended for large olfactory groove meningioma (OGM), recent studies showed that large OGMs can also be resected safely via unilateral approaches. The present study aimed to discuss reasons for preferring a unilateral frontotemporal approach (UFTA), and the technical nuances and results of the UFTA, based on 18 cases. Material and methodsThe clinical and surgical data of patients who had been operated on for large (4–6cm) or giant (>6cm) OGM via a UFTA between 2011 and 2018 were retrospectively collected. ResultsIn all, 18 patients were included. All tumors were compatible with a diagnosis of OGM in the light of peri-operative examinations. 11 cases (61%) were large and 7 (39%) giant OGM; mean diameter was 6.1cm (range, 4-10cm). Resection extent was Simpson grade II in 14 cases (78%), grade III in 1 (5%), and grade IV in 3 (17%). Sixteen cases (89%) had no peri-operative complications, while 2 patients (11%) showed cerebrospinal fluid leakage and hemorrhagic deposition in the surgical area. There were no new neurological deficits nor deaths. ConclusionThe UFTA for OGM is a relatively safe and effective approach, ensuring a high total removal rate with low mortality and morbidity. This study, with a reasonable number of patients, is one of the few in the literature on the outcome of this approach.

Unilateral Subfrontal Approach for Giant Olfactory Groove Meningiomas

Objective: Many approaches have been used for surgical removal of olfactory groove meningioma (OGM) as pterional, bifrontal, interhemispheric, and frontolateral approach. We evaluated the role of unilateral subfrontal approach for the removal of giant OGM “bigger than 6-cm”. Patients and Methods: Nine patients with giant OGM had unilateral subfrontal approach between 1st of January 2015 and December 2017 in Cairo University Hospitals. A retrospective study we done analyzing clinical data, neuroimaging, surgical result and extent of tumor resection. Results: Total tumor resection was achieved in seven cases “Simpson grade I and II”. Subtotal resection was achieved in two cases, one case there was enchasing of the anterior cerebral artery. The other case subtotal resection was achieved due to old age of the patient. The frontal air sinus and cribriform plate and ethmoidal sinus were repaired using fat, fascia lata and vascularized pericranium flab with the use of histoacryl: One case developed hydrocephalus which required the insertion of a ventriculo-peritoneal shunt. One case developed wound infection and meningitis which required medical treatment only. There is no case of CSF leak or mortality in our series. Conclusion: The unilateral subfrontal approach is a safe and efficient approach for removal of giant olfactory groove meningioma. It combines the benefits of the bifrontal, frontolateral and pterional approach with early access to CSF drainage and early attack of the blood supply of the tumor.

Spontaneous recovery of Medial Prefrontal Syndrome following Giant Olfactory Groove Meningioma resection: A case report

Spontaneous recovery of Medial Prefrontal Syndrome following Giant Olfactory Groove Meningioma resection: A case report

The Role of the Expanded Endoscopic Endonasal Approach in Staged Surgery for Giant Olfactory Groove Meningioma: Technical Nuances

The Role of the Expanded Endoscopic Endonasal Approach in Staged Surgery for Giant Olfactory Groove Meningioma: Technical Nuances

Transfrontal-Sinus-Subcranial Approach to Olfactory Groove Meningiomas: Surgical Results and Clinical and Functional Outcome in a Consecutive Series of 21 Patients

The transfrontal-sinus-subcranial approach (TFSSA) allows for direct exposure and removal of olfactory groove meningiomas (OGMs), without any brain retraction. Compared with other skull base approaches (e.g., fronto-orbitobasal, transbasal, subcranial, fronto-orbitozygomatic, and one-and-half approach), it could offer the same advantages but is less invasive. We report the results in a series of 21 consecutive patients with OGMs and operated on through TFSSA, to propose a viable alternative approach. Mean maximum tumor diameter was 45.9 ± 3.4 mm (range, 25-70 mm). The aim of surgery was Simpson grade I removal. Surgical, clinical, and functional outcomes were reported. Mean follow-up was 87 ± 7 months (range, 36-176 months). In all patients, magnetic resonance imaging after surgery confirmed complete tumor removal. The recurrence-free survival rate was 100% and 85.7% at 5 and 10 years, respectively. Surgery-related mortality and major morbidity were 0% and 4.8%, respectively. Risk of anosmia significantly correlates with meningioma size (P < 0.001) and smell sense was preserved only in patients with tumors less than 4 cm in maximum diameter (4/7; 57.1%). A significant improvement of Mini Mental Standard Examination score was recorded at follow-up (P < 0.001) and no patients worsened their cognitive profile. Visual function improved in 7/8 (87.5%). Karnofsky Performance Scale score after surgery significantly increased (P < 0.001). According to the Glasgow Outcome Score, good outcome was achieved in 20 patients (95.2%). Based on reported results, TFSSA allows complete tumor removal with good outcome and low complication rate. It may be proposed as a safe and effective approach to treat large and giant OGMs.

Atypical olfactory groove meningioma associated with uterine fibromatosis; case report

The concomitant presence of the olfactory groove meningioma with uterine fibrosis is very rare. Our report presents the case of a giant olfactory groove meningioma revealed after a uterine fibroma resection in a 44 years-old female, due to a generalized seizure 10 days after operation. Cranial CT-scan identified the tumor as an olfactory groove meningioma. The tumor was operated with a macroscopically complete resection; the endothermal coagulation of the dura attachment was performed (Simpson II) with a good postoperative evolution. Laboratory results showed the presence of receptors for steroid hormones both in meningioma and uterine tumor, and the histopathological examination revealed an atypical meningioma with 17% proliferation markers. Our findings suggest that even though meningiomas are benign tumors and a complete resection usually indicates a good prognosis, the association with uterine fibromatosis and the presence of high percentage of steroid receptors creates a higher risk to relapse, imposing therefore a good monitoring.

Unilateral Tailored Fronto-orbital Approach for Giant Olfactory Groove Meningiomas: Technical Nuances

Objective: Giant olfactory groove meningiomas (maximum diameter ‡6 cm) remain a surgical challenge. Historically, extensive anterior and antero-lateral ap-proaches have been the primary approaches for removal of such large tumors with limitations and morbidity pertaining to each approach. Herein, the authors describe a minimally invasive, unilateral, tailored fronto-orbital approach for resection of these complex lesions with an emphasis on preservation of the anterior cerebral arteries and olfactory nerves.

Unilateral Tailored Fronto-Orbital Approach for Giant Olfactory Groove Meningiomas: Technical Nuances

Giant olfactory groove meningiomas (maximum diameter ≥6 cm) remain a surgical challenge. Historically, extensive anterior and antero-lateral approaches have been the primary approaches for removal of such large tumors with limitations and morbidity pertaining to each approach. Herein, the authors describe a minimally invasive, unilateral, tailored fronto-orbital approach for resection of these complex lesions with an emphasis on preservation of the anterior cerebral arteries and olfactory nerves. A 4-stage approach using neuronavigation is performed: 1) predefined corridor, 2) identification of the ipsilateral anterior cerebral artery, 3) postdefined corridor, and 4) tumor base. The details of this approach are described below in a stepwise fashion and supplemented by a sample of 3 cases utilizing this technique. In the 3 representative cases in which this technique was used, gross total resection was achieved without injury to any of the adjacent neurovascular structures. Significant sellar extension can be resected through a second stage endoscopic endonasal approach. Giant olfactory groove meningiomas (≥6 cm) can be safely and completely resected with this 4-stage, unilateral fronto-orbital technique. Furthermore, early identification and preservation of the adjacent critical neurovascular structures can be achieved. This technique avoids the inherent limitations and morbidity associated with the more classic pterional and bifrontal approaches respectively while minimizing normal tissue disruption.

Giant Invasive Olfactory Groove Meningioma in a 13-Year-Old Boy with Invasion to PNS and Orbit: A Case Report and Literatures Review

Objective: To report the surgical outcome of resection in a giant olfactory groove meningioma with involving the PNS and orbit. Study Design: A case report and report of surgical technique and review of literatures. Patient: A 13-year-old boy presented with proptosis, diplopia, and nasal fullness. CT and MRI showed a large enhancing mass in planum sphenoidal, olfactory groove, PNS, and bilateral orbit. Endoscopic biopsy showed WHO grade 1 meningioma. Total surgical resection and reconstruction of skull base and orbit was performed in one stage with transbasal and endoscopic approach. Results: After surgical resection and reconstruction patient's symptoms and diplopia was resolved. During early follow-up we did not have postoperative CSF leak and other complications. Pathology revealed any atypical features. Conclusions: We report a rare case of childhood brain tumor with unusual extension that is treated with radical excision and reconstruction. Radical excision and reconstruction is the best operative option in benign meningioma.

Expanded endonasal approach for olfactory groove meningioma

We were greatly interested to read the paper by Gazzeri et al. “Giant olfactory groove meningioma: ophtalmological and cognitive outcome after bifrontal microsurgical approach” published in the November 2008 issue of Acta Neurochirurgica [2]. The authors are to be particularly commended for completing a routine assessment of cognitive function preoperatively, 1-month, and 1-year postoperatively. The article nicely illustrates that visual and cognitive dysfunction does improve after surgery and that most of the improvement occurs within the first month. As a conclusion, the authors stated that the bifrontal approach may be considered the most appropriate for these tumors. Olfactory groove meningiomas arise in the midline along the dura of the cribiform plate and occupy the anterior cranial fossa extending from the crista galli to the tubercullum sellae. Expanded endonasal approaches (EEA) have been developed in an attempt to eliminate brain retraction as well as improve ophthalmological outcomes by approaching anterior skull base tumors from anteromedial and inferior trajectory [4]. At our institution, olfactory groove meningiomas are routinely treated using an EEA transcribiform module. Advantages of this endoscopic minimally invasive approach include removal of involved bone and dura as a part of the approach (facilitating Simpson Grade I resections), early tumor devascularization (anterior and posterior ethmoidal arteries are eliminated during the exposure), direct tumor access without any brain exposed, absolute avoidance of brain retraction, and complete bilateral optic canal decompression. Perhaps the most important potential advantage is the avoidance of manipulation of edematous and engorged frontal lobes, as well as ischemic, compressed optic apparatus [1]. Although initial CSF leak rate after EEAs was as high as 40%, with the current use of the pedicled nasoseptal flap for reconstruction the overall CSF leak rate has been reduced to 5.4% [3, 5]. In our experience, the main concern of EEA for an olfactory groove meningioma is the risk of vascular injury to A2 segments and frontopolar arteries as they are often draped over the posterior surface of large tumors. We believe that lesions with potential for such vascular injury should probably be managed only after significant EEA experience has been gained with other pathology and approaches. Unfortunately, presumably because of its limited reports, the EEA as a feasible treatment for olfactory groove meningiomas was not mentioned in the Gazzeri et al. article. This article is exciting as it emphasizes cognitive outcomes for these tumors that we believe to be critical outcome measures. EEA may hold potential to maximize these outcomes by eliminating even minimal brain retraction, the effect of which is poorly understood, especially in the setting of already compromised function.

Giant olfactory groove meningioma: ophthalmological and cognitive outcome after bifrontal microsurgical approach

Olfactory groove meningiomas arise in the midline along the dura of the cribriform plate and may reach a large size before producing symptoms. We conducted a retrospective study of patients with these lesions focused on pre- and post-operative investigations for ophthalmological, personality and cognitive disturbances. The authors reviewed 36 patients with giant olfactory groove meningiomas surgically treated via a bifrontal approach. Ophthalmological evaluation included visual acuity, fundoscopy and visual fields while psychological evaluation included a Mini-Mental State Examination. Data was collected before, 1 and 12 months after surgery. Formal pre- and post-operative ophthalmological examinations discovered visual deficits in 55.5% of the patients. Within the first month after surgery, improvement of visual acuity and of visual field deficits was observed. In post-operative neuropsychological testing, higher mental functions showed improvement. The most frequent post-operative complication was persistent rhinorrhoea in two patients. Results at longest follow up indicate that cognitive changes and visual deficits will improve in patients with giant olfactory groove meningiomas after a bifrontal approach, without additional neurological deficits.

Giant olfactory groove meningiomas: advantages of the bilateral fronto-orbitonasal approach.

Olfactory groove meningiomas are usually considered surgically curable, but the operation becomes complex when the tumour reaches massive size and involves vital suprasellar structures, extends into the ethmoid sinuses or extensively involves the bony floor of the anterior fossa. The traditional bifrontal approach provides only limited exposure in these situations, and a bilateral fronto-orbitonasal approach may be more effective. We reviewed our experience in five patients with resections of massive olfactory groove meningiomas to assess the advantages and risks of these two approaches. All patients were women (mean age, 45 years; range, 28-59) presenting with symptoms and signs related to increased intracranial pressure, cranial nerve impairment or brain compression. Computed tomography, magnetic resonance imaging and cerebral angiography were used for diagnosis and operative planning. The approach was bifrontal in two patients and bifronto-orbitonasal in three. Total surgical removal (Simpson grade I, three patients; Simpson grade II, one patient) was achieved in four patients (80%) and subtotal tumour removal (Simpson grade III) was performed in one (20%). One patient had two staged operations. No morbidity or mortality occurred in this series. No clinical or radiologic evidence of recurrence developed in the four patients whose tumour was resected totally. The bilateral fronto-orbitonasal approach resulted in safe and successful total removal of giant olfactory groove meningiomas, achieving long-term prevention of recurrence. We highly recommend this approach. Copyright 1999 Harcourt Publishers Ltd.

Resection of Giant Olfactory Groove Meningioma with Extradural Devascularization

A 55-year-old male patient presented with a giant olfactory groove meningioma supplied by both ophthalmic arteries. The tumor was debulked through a bifrontal craniotomy, but the surgery was discontinued because of extensive blood loss. During a second operation, the dura of the frontal base was dissected extradurally before the tumor was removed. The meningeal blood supply was occluded with bipolar coagulation of the epidural meningeal vessels around the crista galli. The highly vascular tumor then was totally removed with considerably less blood loss. The patient's postoperative course was uneventful. Because the ophthalmic artery cannot be embolized preoperatively, the direct extradural approach to the skull base to devascularize the blood supply around the olfactory groove may reduce blood loss and facilitate resection.

Resection of Giant Olfactory Groove Meningioma with Extradural Devascularization

A 55-year-old male patient presented with a giant olfactory groove meningioma supplied by both ophthalmic arteries. The tumor was debulked through a bifrontal craniotomy, but the surgery was discontinued because of extensive blood loss. During a second operation, the dura of the frontal base was dissected extradurally before the tumor was removed. The meningeal blood supply was occluded with bipolar coagulation of the epidural meningeal vessels around the crista galli. The highly vascular tumor then was totally removed with considerably less blood loss. The patient's postoperative course was uneventful. Because the ophthalmic artery cannot be embolized preoperatively, the direct extradural approach to the skull base to devascularize the blood supply around the olfactory groove may reduce blood loss and facilitate resection.