Olfactory Groove Meningiomas Research Articles

Giant Olfactory Groove Meningiomas: A Case Series Demonstrating the Surgical Management and Functional Outcomes

Abstract Objective Giant olfactory groove meningiomas (OGMs) present technical challenges in their management, especially when their size and location complicate the evaluation and planning process, making complete removal difficult. This study provides a comprehensive analysis of the surgical approaches and outcomes encountered in the management of giant OGMs at a single institution. Materials and Methods This retrospective study evaluated surgical and functional outcomes in 71 patients diagnosed with giant OGMs larger than 6 cm. Tumors were excised using microsurgical resection via the bifrontal, pterional, or combined pterional and unifrontal approaches. Results The study comprised 48 females (67.6%) and 23 males (32.4%), with a mean age of 54.1 years. The most common pathological type was meningothelial meningioma (45%). The bifrontal approach was the most frequently used (n = 47, 66.2%) and resulted in Simpson grade I or II resection in 41 patients (87.2%). The combined pterional and unifrontal approaches were used in 16 patients (22.5%), achieving Simpson grade I or II resection in 12 (75%). The pterional approach was the least commonly used (n = 8), with Simpson grade I or II resection achieved in 50% of these patients. Postoperatively, visual acuity and cognitive function improved during follow-up. Postoperative complications were frequently observed after the bifrontal approach. Three patients (4.2%) died. Conclusion The bifrontal approach resulted in better resection of giant OGMs than other approaches but was associated with more complications. The combined pterional and unifrontal approach was superior to the pterional approach in terms of OGM resection, with no differences in complication rates. Significant postoperative improvements in functional outcomes, including visual acuity and cognitive function, were observed.

Meta-Analysis Report: Olfactory Groove Meningioma

Objective: This meta-analysis aims to evaluate the clinical outcomes, surgical techniques, and complications associated with the resection of olfactory groove meningiomas (OGMs). Methods: A systematic review of the literature was conducted, focusing on studies that reported on surgical outcomes for OGMs. Data were extracted on patient demographics, surgical approaches, outcomes, and complications. Results: Surgical resection of OGMs was associated with favorable functional outcomes, although complications, including anosmia and neurological deficits, were common. Total resection rates varied based on surgical technique. Conclusion: Resection of olfactory groove meningiomas generally yields good outcomes, but careful consideration of surgical approach is essential to minimize complications

Olfactory Groove Meningiomas and the Association with Postoperative Weight Loss

Abstract Objective Olfactory groove meningiomas (OGM) commonly present with olfactory deficits and compression of the frontal lobes. Given the relationship to dietary behaviors, our objective was to evaluate the relationship between OGMs and postoperative weight loss. Methods Retrospective review of primary resection of meningiomas between 2017 and 2023 at a single institution was conducted. Neurofibromatosis type 2, pregnancy, weight loss medications, or surgeries were excluded. Data collection included preoperative body mass index (preBMI) and postoperative BMI (poBMI) at 3 to 6 and 12 months. Percent BMI change (pcBMI) was calculated by (poBMI − preBMI/preBMI × 100%). IBM SPSS Statistics (Version 27) was used for descriptive statistics and stepwise multiple linear regression. Results Ninety-eight patients met inclusion with a mean age of 57.58 years. Three groups were stratified by location: OGM (n = 15), anterior cranial fossa excluding OGM (ACF; n = 24), and other (OTH; n = 59). Olfactory dysfunction was present in 53.8% of the OGMs. OGM presented with significantly larger lesions (57.25 ± 55.98 mm3) and a higher preBMI (34.58 ± 7.41 kg/m2) than ACF and OTH. A greater pcBMI was seen in OGM at both timepoints (−7.74%, −8.73%). OGM location, tumor volume, and preBMI were found significant on univariate analysis (p < 0.05) and included in multiple linear regression. All regression models were significant (p = 0.001). Location significantly added to the prediction at 3 to 6 and 12 months as well as preBMI at 12 months. In a subanalysis of ACF and OGM, OGM location was significantly associated with negative pcBMI at 3 to 6 and 12 months. Conclusion OGMs are associated with higher preoperative weight and greater weight loss postoperatively compared with other locations.

A modern approach to olfactory groove meningiomas.

Management of olfactory groove meningiomas (OGMs) has changed significantly with the advances in extended endoscopic endonasal approaches (EEAs), which is an excellent approach for patients with anosmia since it allows early devascularization and minimizes retraction on the frontal lobes. Craniotomy is best suited for preservation of olfaction. However, not infrequently, a tumor presents after extending outside the reach of an EEA and a solely transcranial approach would require manipulation and retraction of the frontal lobes. These OGMs may best be treated by a staged EEA-craniotomy approach. In this study the authors' goal was to present their case series of patients with OGMs treated with their surgical approach algorithm. The authors conducted an IRB-approved, nonrandomized historic cohort including all consecutive cases of OGMs treated surgically between 2010 and 2020. Patient demographic information, presenting symptoms, operative details, and complications data were collected. Preoperative and postoperative tumor and T2/FLAIR intensity volumes were calculated using Visage Imaging software. Thirty-one patients with OGMs were treated (14 craniotomy only, 11 EEA only, and 6 staged). There was a significant difference in the distribution of patients presenting with anosmia and visual disturbance by approach. Tumor size was significantly correlated with preoperative vasogenic edema. Gross-total resection was achieved in 90% of cases, with near-total resection occurring twice with EEA and once with a staged approach. T2/FLAIR hyperintensity completely resolved in 90% of cases and rates did not differ by approach. Complication rates were not significantly different by approach and included 4 CSF leaks (p = 0.68). A staged approach for the management of large OGMs with associated anosmia and significant lateral extension is a safe and effective option for surgical management. Through utilization of the described algorithm, the authors achieved a high rate of GTR, and this strategy may be considered for large OGMs.

Surgical Approaches to Resection of Olfactory Groove Meningiomas: Comparative Meta-analysis of the Endoscopic Endonasal versus Transcranial and Unilateral versus Bilateral Approaches

Abstract Introduction Here we systematically review the extant literature to highlight the advantages of bilateral versus unilateral approaches and endoscopic endonasal (midline) approaches versus transcranial approaches for olfactory groove meningiomas, focusing on complications, extent of resection, and local recurrence rates. Methods Three databases were queried to identify all primary prospective trials and retrospective series comparing outcomes following endoscopic endonasal versus transcranial approaches and unilateral versus bilateral craniotomy for surgical resection of olfactory groove meningiomas. All articles were screened by two independent authors and selected for formal analysis according to predefined inclusion/exclusion criteria. Results Seven studies comprising 288 total patients (mean age 55.0 ± 24.6 years) met criteria for inclusion. In the three comparing the endoscopic endonasal (n = 21) versus transcranial (n = 32) approaches, there was no significant difference between the two with respect to gross total resection (p = 0.34) or rates of Simpson Grade 1 resection (p = 0.69). EEA demonstrated higher rates of overall complications (p < 0.01) including postoperative infection (p = 0.03). In the four studies comparing bilateral (n = 117) versus unilateral approaches (n = 118), overall complication rates (p < 0.01) and disease recurrence (p = 0.01) were higher with bilateral approaches. All surgery-related mortalities also occurred in the bilateral cohort (n = 7, 7.14%). Gross total resection (p = 0.63) and Simpson grade (p = 0.48) were comparable between approaches. Olfaction preservation was superior for unilateral approaches (p < 0.01). Conclusions Though the literature is limited, current evidence suggests that the endoscopic endonasal approach may be favorable over conventional craniotomy for select olfactory groove meningioma patients. Where craniotomy is used, unilateral approaches appear to reduce complications and the risk of olfaction loss.

Taste dysfunction after endoscopic endonasal resection of olfactory groove meningioma: Case series and review of the literature

PurposeThe incidence of ageusia and dysgeusia after endoscopic endonasal (EEA) resection of olfactory groove meningioma (OGM) is not well established despite recognized impairment in olfactory function. MethodsWe retrospectively administered a validated taste and smell survey to patients undergoing EEA for resection of OGM at two institutions. Demographics and clinical characteristics were collected and survey responses were analyzed. ResultsTwelve patients completed the survey. The median time from surgery was 24 months. The average total complaint score was 5.5 out of 16 [0–13]. All patients reported a change in sense of smell while only 42 % reported a change in sense of taste. Taste changes did not consistently associate with laterality or size of the neoplasm. Significant heterogeneity existed when rating severity of symptoms. ConclusionsTo our knowledge this is the first case series examining taste changes after EEA resection of OGM. Despite universal olfactory dysfunction, only a minority of patients reported a change in their sense of taste. Our findings may improve patient counseling and expectations after surgery.

Correlation of Molecular Status with Preoperative Olfactory Function in Olfactory Groove Meningioma.

The study aims to examine the possible correlation between genomic alterations and preoperative olfactory function in patients with olfactory groove meningioma (OGM), due to the frequent presence of olfactory impairment. We utilised next-generation sequencing to analyse samples from 22 individuals with OGM in order to detect driver mutations. Tumour morphology was assessed using preoperative imaging, whereas olfactory function was examined using Sniffin' Sticks. In a study of 22 OGM patients, mutations were as follows: 10 with SMO/SUFU, 7 with AKT1, and 5 as wild type. Planum sphenoidale hyperostosis (PSH) was present in 75% of patients, showing significant variation by mutation (p = 0.048). Tumour volumes, averaging 25 cm3, significantly differed among groups. PSH negatively impacted olfaction, notably affecting odour threshold, discrimination, identification, and global olfactory performance score (TDI) (p values ranging from <0.001 to 0.003). Perifocal oedema was associated with lower TDI (p = 0.009) and altered threshold scores (p = 0.038). Age over 65 and female gender were linked to lower thresholds and discrimination scores (p = 0.037 and p = 0.019). The study highlights PSH and perifocal oedema's significant effect on olfactory function in OGM patients but finds no link between olfactory impairment and tumour mutations, possibly due to the small sample size. This suggests that age and gender affect olfactory impairment. Additional research with a larger group of participants is needed to explore the impact of OGM driver mutations on olfactory performance.

Endoscopic endonasal approach for olfactory groove meningioma resection: Strategies and outcomes in a retrospective case series

ObjectiveThough the endoscopic endonasal approach (EEA) is a widely accepted treatment for skull base tumors, the specific use of EEA for olfactory groove meningiomas (OGMs) is debated, with variable outcomes reported in the literature. We review the surgical results of OGM resections for one surgeon including the operative approach, surgical nuances, and outcomes, with a focus on factors relating to patient selection which favor EEA over transcranial approaches. MethodsWe retrospectively reviewed thirteen cases of endoscopic endonasal resection of olfactory groove meningiomas. Patient characteristics, clinical characteristics, surgical outcomes, and complications were analyzed. Extent of resection was determined based on volumetric analysis of pre- and postoperative MRI. ResultsAnatomic characteristics that render a tumor difficult to access fully are lateral extension beyond the mid-orbit and anterior extension to the falx. Simpson Grade I resection was achieved in 11/13 (84.6 %) cases. Mean pre-operative tumor volume was 8.99 cm3 (range 2.19–16.79 cm3), and 92 % of tumors were WHO grade I. We demonstrate 2 cases of smell preservation, possible with small unilateral tumors and tumors that are confined to either the anterior or posterior portion of the cribriform plate. The post-operative CSF leak rate was 7.7 %, without prophylactic lumbar CSF drainage. The mortality rate was 7.7 % (n = 1) after infectious complications following CSF leak. ConclusionsEndoscopic endonasal resection of olfactory groove meningiomas is an effective and safe operative method with outcomes and complication rates comparable to transcranial approaches. Key considerations include careful patient selection and familiarity with technical nuances of endoscopic endonasal approach for this specific tumor type.

CASE REPORT : OLFACTORY GROOVE MENINGIOMA

Abstract&#x0D; Background: Olfactory Groove Meningiomas (OGM) are a rare cause of olfactory dysfunction. OGMs are benign, slow-growing tumors that cause non-specific symptoms, such as headaches, olfactory impairment, and psychiatric symptoms, such as depression, personality changes, decreased cognitive function, visual problems, or seizures.&#x0D; Aim: In this case report we would like to discuss about a rare case of olfactory groove meningioma with non-spesific symptoms presented in 47-year old female patient&#x0D; Case report: A 47-year old female with progressive blurred vision in the right eye for 3 months. Negative light perception in the right eye and fundus of the right eye indicated papillary atrophy. The direct and indirect light reflexes were negative in the right eye. We found Strong homogenous contrast enhancement extraaxial lesion accompanied by multiple dural tails in the left frontal convexity UK approximately 3.2 x 2.8 x 3.1 cm, Tuberculum sellae approximately 2.7 x 2.9 x 3 cm. Cranial decompression, frontal bone reconstruction, and tumor removal were performed. It was found that there was microcystic growth of tumor tissue, consisting of proliferation of meningoethelial cells, round to oval nuclei, smooth chromatin, visible intranuclear inclusions&#x0D; Discussion: OGM is a rare, benign tumor. Female patients were more likely to develop OGM than male patients. The ciliary ganglion of cranial nerve III may be affected by compression of the tumor, resulting in the absence of direct and indirect pupillary reflexes in the affected eyes.&#x0D; Conclusion: OGM is a slow-growing tumor that does not show significant symptoms at an early stage, making early detection difficult.&#x0D; Keyword: Olfactory Groove Meningioma, Blurred Vision, Meningioma&#x0D;

Commentary: Superior Ethmoidal Approach to an Olfactory Groove Meningioma: Maximizing Preservation of Nasal Anatomy.

Commentary: Superior Ethmoidal Approach to an Olfactory Groove Meningioma: Maximizing Preservation of Nasal Anatomy.

Anosmia due to bilateral papillary atrophy : a case report

Abstract&#x0D; Introduction : Papillary atrophy refers to degeneration of the optic nerve, which occurs as an end result of a pathological process that damages the axons, with ophthalmoscopic observation showing pallor of the optic nerve papillae which generally accompanies permanent damage to the optic nerve.&#x0D; Case Illustration : It was reported that a 36 year old woman came to the polyclinic with complaints of not being able to see in both eyes since 8 months ago. Complaints of blurred vision in both eyes are followed by smell that cannot smell. This complaint has been getting worse for the past 2 weeks. On brain MRI examination, results were obtained with SOL impressions in the midline frontalis area with perifocal edema ec, suspected olfactory groove meningioma.&#x0D; Discussion : In this case SOL is located in the midline frontal area so that the patient complains of loss of smell sensation (anosmia). The presence of a frontal or subfrontal tumor can compress the optic tract and optic nerve together. Optic tract compression will cause anosmia. Olfactory disturbances are strongly associated with anterior cerebral fossa tumors.&#x0D; Conclusion : Secondary papillary atrophy is caused by increased intracranial pressure caused by a mass tumor which is preceded by papilledema signs and eventually becomes papillary atrophy, and gives a pale optic papillae with blurred boundaries. Brain CT scan examinations are important to estimate the location of the lesion.

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.

Endonasal, supraorbital, and transorbital approaches: minimal access endoscope-assisted surgical approaches for meningiomas in the anterior and middle cranial fossae.

Minimally invasive endoscope-assisted approaches to the anterior skull base offer an alternative to traditional open craniotomies. Given the restrictive operative corridor, appropriate case selection is critical for success. In this paper, the authors present the results of three different minimal access approaches to meningiomas of the anterior and middle fossae and examine the differences in the target areas considered appropriate for each approach, as well as the outcomes, to determine whether the surgical goals were achieved. A consecutive series of the endoscopic endonasal approach (EEA), supraorbital approach (SOA), or transorbital approach (TOA) for newly diagnosed meningiomas of the anterior and middle fossa skull base between 2007 and 2022 were examined. Probabilistic heat maps were created to display the distribution of tumor volumes for each approach. Gross-total resection (GTR), extent of resection, visual and olfactory outcomes, and postoperative complications were assessed. Of 525 patients who had meningioma resection, 88 (16.7%) were included in this study. EEA was performed for planum sphenoidale and tuberculum sellae meningiomas (n = 44), SOA for olfactory groove and anterior clinoid meningiomas (n = 36), and TOA for spheno-orbital and middle fossa meningiomas (n = 8). The largest tumors were treated using SOA (mean volume 28 ± 29 cm3), followed by TOA (mean volume 10 ± 10 cm3) and EEA (mean volume 9 ± 8 cm3) (p = 0.024). Most cases (91%) were WHO grade I. GTR was achieved in 84% of patients (n = 74), which was similar to the rates for EEA (84%) and SOA (92%), but lower than that for TOA (50%) (p = 0.002), the latter attributable to spheno-orbital (GTR: 33%) not middle fossa (GTR: 100%) tumors. There were 7 (8%) CSF leaks: 5 (11%) from EEA, 1 (3%) from SOA, and 1 (13%) from TOA (p = 0.326). All resolved with lumbar drainage except for 1 EEA leak that required a reoperation. Minimally invasive approaches for anterior and middle fossa skull base meningiomas require careful case selection. GTR rates are equally high for all approaches except for spheno-orbital meningiomas, where alleviation of proptosis and not GTR is the primary goal of surgery. New anosmia was most common after EEA.

Surgical resection of an olfactory groove meningioma using a 3D-printing technique in a dog

Surgical resection of an olfactory groove meningioma using a 3D-printing technique in a dog

Olfactory groove meningiomas: supraorbital keyhole versus orbitofrontal, frontotemporal, or bifrontal approaches.

Olfactory groove meningiomas (OGMs) often require surgical removal. The introduction of recent keyhole approaches raises the question of whether these tumors may be better treated through a smaller cranial opening. One such approach, the supraorbital keyhole craniotomy, has never been compared with more traditional open transcranial approaches with regard to outcome. In this study, the authors compared clinical, radiographic, and functional quality of life (QOL) outcomes between the keyhole supraorbital approach (SOA) and traditional transcranial approach (TTA) for OGMs. They sought to examine the potential advantages and disadvantages of open/TTA versus keyhole SOA for the resection of OGMs in a relatively case-matched series of patients. A retrospective, single-institution review of 57 patients undergoing a keyhole SOA or larger traditional transcranial (frontotemporal, pterional, or bifrontal) craniotomy for newly diagnosed OGMs between 2005 and 2023 was performed. Extent of resection, olfaction, length of stay (LOS), radiographic volumetric assessment of postoperative vasogenic and cytotoxic edema, and QOL (using the Anterior Skull Base Questionnaire) were assessed. Thirty-two SOA and 25 TTA patients were included. The mean EOR was not significantly different by approach (TTA: 99.1% vs SOA: 98.4%, p = 0.91). Olfaction was preserved or improved at similar rates (TTA: 47% vs SOA: 43%, p = 0.99). The mean LOS was significantly shorter for SOA patients (4.1 ± 2.8 days) than for TTA patients (9.4 ± 11.2 days) (p = 0.002). The authors found an association between an increase in postoperative FLAIR cerebral edema and TTA (p = 0.031). QOL as assessed by the ASQB at last follow-up did not differ significantly between groups (p = 0.74). The keyhole SOA was associated with a statistically significant decrease in LOS and less postoperative edema relative to traditional open approaches.

SURG-37. ONCOGENIC MUTATIONS AND TUMOR CHARACTERISTICS IN OLFACTORY GROOVE MENINGIOMAS: IMPLICATIONS FOR PERSONALIZED TREATMENT STRATEGIES

Abstract OBJECTIVE To investigate the correlation between clinical and radiologic features of olfactory groove meningiomas (OGM) and their tumor molecular profiles, focusing on oncogenic mutations identified through genomic studies. METHODS Targeted next-generation sequencing analyses were conducted on 54 patients with OGM (37 females and 17 males) to determine the frequency of SMO, AKT1, PIK3CA, and other mutations. The molecular results were then correlated with clinical and radiographic tumor features. RESULTS Among the OGM patients, SMO mutations were found in 16 (29.6%) cases, AKT1 mutations in 13 (24.1%), and PIK3CA/PIK3R1 mutations in 9 (16.7%) cases. Less common mutations in POLR2A, SUFU, and NF1 were observed in 8 (14.8%) cases, while 8 OGM (14.8%) did not have identifiable driver mutations (Wild-type group, WT). The median age at first diagnosis was 64.1 years (25-87 years), with the youngest group represented by PIK3CA-mutant patients at 52 years (49-78 years). The sex distribution was similar across the SMO-, AKT1- and PIK3CA-mutant groups (F:M = 2.1:1). OGM with SMO mutations exhibited larger tumor volumes (329.4 ± 323.0 cm3) compared to AKT1-mutant tumors (283.3 ± 156.2 cm3). Tumor infiltration of the ethmoid cells was found in 10 cases (22.2%), with the highest rate observed in PIK3CA-mutant OGM (40%), followed by 25% in SMO-mutant OGM. Tumor-associated hyperostosis of the sphenoid planum was common in OGM (72.2%), with the highest rate in the SMO group (75.0%) and the lowest rate in the AKT1-mutant group (30.8%). The majority of cases (n = 45, 83.3%) were classified as WHO grade 1 meningioma, while the remaining nine cases were WHO grade 2 (n = 8) and 3 (n = 1). CONCLUSIONS Overall, our data demonstrate the presence of clinically actionable mutations in the majority of olfactory groove meningiomas, and suggest a correlation between molecular status and common clinical and radiologic tumor features.

SURG-25. SURGICAL MORBIDITY IN RELATION TO THE SURGICAL APPROACH FOR OLFACTORY GROOVE MENINGIOMAS—A POOLED ANALYSIS OF 1016 PATIENTS AND PROPOSAL OF A NEW REPORTING SYSTEM

Abstract BACKGROUND There is no consensus regarding whether a frontal or lateral approach is superior for resection of olfactory groove meningiomas (OGM). Objective: 1) To compare surgical approaches for microsurgical resection of OGMs for extent of resection and complication rates. 2) To develop a novel preoperative scoring system to guide choice of approach to decrease surgical morbidity. METHODS A PRISMA-guided pooled analysis of 20,672 surgical reports on OGMs published in the MRI era using search terms such as ‘olfactory groove meningioma’ and ‘surgery’. After title screening and removal of duplicates, we assessed 871 studies on surgical management of OGMs. Following exclusion criteria, 27 studies were chosen for the final pooled cohort analysis of reported patient outcomes. RESULTS The 27 studies identified a total of 1,016 individual patients who underwent open microsurgical resection of OGMs. The approaches used included: pterional/unilateral, bifrontal with variations, and anterior interhemispheric approaches. Across all studies, gross total resection (Simpson Grades I or II) was achieved in 91.4% of cases, and subtotal resection (Grades III and IV) was reported in 8.6% of cases. A cumulative 27% of surgical OGM patients sustained some form of complications. Minor complications 22.2% (CSF leak, seizures, infection, transient cranial nerve palsies, hydrocephalus). Major complications 4.7% (hemorrhage, ischemic infarct, malignant cerebral edema). Correlation between complications and the surgical approach was performed. Among 426 patients who underwent unilateral approaches, 14% experienced minor complications, and 2.1% experienced major complications. The 410 patients who underwent bifrontal approaches, 24.6% experienced minor complications, and 7% experienced major complications. CONCLUSIONS Unilateral approaches appear to have lower complication rates than bilateral approaches, however, the extent of resection is not uniformly reported, making it difficult to identify differences. We herein propose a novel preoperative imaging-based classification scoring system to help select the most suitable surgical approach to achieve lower post-surgical complication rates.

DISP-11. PROMINENT FRONTAL BOSSING AND BLINDNESS FOLLOWING SUBTOTAL RESECTION OF LOW-GRADE MENINGIOMA: HIGHLIGHTING HEALTH DISPARITIES

Abstract Low-grade meningiomas with subtotal resection carry significantly shorter recurrence-free survival rates than those with gross total resection. We report the natural history of a case of low-grade meningioma after subtotal resection and review the literature. We aim to highlight known global health disparities in oncology treatment by describing a case of meningioma progression following subtotal resection. A 40-year-old Kenyan woman presented locally with headache, nausea, and vision loss over approximately a six month time period. A 5 cm olfactory groove meningioma was discovered, and she subsequently underwent subtotal resection that was likely limited due to hemorrhagic complications. Over the following two years, she developed progressive dizziness, nausea, gait instability, difficulty performing tasks, and visual loss prompting medical evaluation at our institution. Physical examination demonstrated blindness, bilateral proptosis with severe vertical gaze palsy, and prominent frontal bossing. MRI Brain revealed a 9 cm enhancing mass arising from the cribriform plate with elevation of an ununited overlying frontal craniotomy flap and apparent meningoceles extending through the presumed osteotomy bilaterally. She underwent successful resection with pathology demonstrating CNS WHO Grade 1 meningioma. Her postoperative neurologic exam showed subtle improvement, specifically in regards to orientation questions. In this patient, bone flap displacement from prior craniotomy allowed significant interval tumor growth while minimizing mass effect on brain parenchyma. This case highlights global health disparities in low-grade meningioma management related to appropriate healthcare access in underserved patients.

Frontal trans-sinusal approach: how I do it.

Anterior skull base lesions could be reached by different approaches (subfrontal, pterional, interhemispheric, etc.). In selected cases, the frontal trans-sinusal approach is an effective alternative to conventional techniques. We present our technique to perform a frontal trans-sinusal approach in a patient affected by a large olfactory groove meningioma. The frontal trans-sinusal approach allows to approach safely lesions of the median anterior cranial fossa. This approach provides lower brain retraction, easier access to olfactory grooves, and earlier tumor devascularization. However, it remains limited to patients with large-sized frontal sinuses and entails some postoperative risks such as mucocele or CSF leak.

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.