Removal Of Olfactory Groove Meningiomas Research Articles

Neuropsychological Outcomes after Surgery for Olfactory Groove Meningiomas.

Simple SummaryOlfactory groove meningiomas account for 9% of all meningiomas, present with unique molecular characteristics and are standardly treated by surgical removal. Due to their location (in direct contact with cortical structures exerting key-role functions in cognition), olfactory groove meningiomas might negatively impact cognitive abilities. However, little is known about the effects of both their presence and surgical removal on patients’ neuropsychological functions. In this retrospective study, we analyze the evolution of neuropsychological abilities in 17 patients benefitting from surgical removal of an olfactory groove meningioma. We observed that those patients already presented with preoperative deficits in pre-frontal cortex cognitive functions, more pronounced in the domain of cognitive flexibility, followed by attention. After an initial postoperative worsening, patients tended to improve in the majority of cognitive aspects, with attention and flexibility remaining impaired at one-year follow-up.Background: In recent years, several studies have reported abnormal pre- and postoperative neuropsychological functioning in patients with meningiomas located in the prefrontal cortex (notably the ventromedial region). In the case of olfactory groove meningiomas, the tumor is in direct contact with the inferior aspect of the prefrontal cortex, a cortical region with crucial roles in decision-making, cognition and memory functions, potentially negatively impacting neuropsychological functions. Materials and Methods: We retrospectively compared pre- and post-operative neuropsychological testing of 17 patients undergoing surgical removal of olfactory groove meningiomas in our institution between January 2013 and December 2018. Neuropsychological results were obtained from the patients’ medical history and normalized as z-scores of their respective cognitive functions. Results: Assessment of cognitive follow-up showed an important heterogeneity among patients. Pre-operative cognitive impairment was observed in most patients, particularly in cognitive flexibility (mean z-score: −1.35). Immediate post-operative cognitive status showed an overall impairment in all domains of cognition, significant for the domains of attention (p = 0.0273) and flexibility (p = 0.0234) and almost significant for the domain of language (p = 0.0547). The late follow-up at one year showed a trend towards general improvement, although attention and flexibility remained impaired. Discussion: Olfactory groove meningiomas impact pre-frontal cortex cognitive functions, particularly in the domain of cognitive flexibility. After an initial postoperative worsening, patients tended to improve in most aspects after one year, aside from cognitive flexibility and attention.

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.

单侧额下入路显微切除嗅沟脑膜瘤

目的：探讨单侧额下入路显微切除嗅沟脑膜瘤的技巧和疗效。方法：在2004年1月至2015年5月采用经单侧额下入路显微切除巨大嗅沟脑膜瘤45例，其中男11例，女34例；平均年龄49.2岁(22~78岁)。肿瘤最大直径平均4.9 cm (2.2 cm~8.1 cm)。回顾性分析所有患者的临床数据、影像特征、手术记录和预后，采用非配对资料χ2检验结果连续性校正法分析预后影响因素。结果：全切(Simpson grade I/II/III)41例(91.1%)，少许残留4例(8.9%)，其中1例行伽玛刀治疗。主要并发症：颅内感染3例，额叶挫伤5例(11.1%)，其中伴血肿需手术清除1例。新增嗅觉损失9例(20.0%)，额叶损伤症状3例，脑脊液漏2例，视力减退1例，脑肿胀1例，癫痫发作1例，脑积水1例。出院后3~6个月，预后良好38例(84.4%)，中残6例(13.3%)，重残1例(2.2%)术前KPS评分 ≤ 70与不良预后相关(χ2 = 5.139, P = 0.023)。41例(91.1%)获随访，平均随访时间42.6个月(3~107个月)，KPS计分85.2分；3例(7.3%)复发，均行伽玛刀治疗，1例再手术。结论：应用适宜手术技巧，单侧额下入路显微切除巨大嗅沟脑膜瘤疗效确切，并发症较少；术前KPS ≤ 70分是嗅沟脑膜瘤手术不良预后因素。 Objective: To investigate the techniques and clinical effects for removal of olfactory groove meningiomas (OGMs) via unilateral subfrontal approach. Methods: Between January 2004 and May 2015, a total of 45 OGM patients were operated on via the unilateral subfrontal approach. There were 11 male patients and 34 female patients. Their mean age was 49.2 (22~78) years. The average maximal tumor diameter was 4.9 cm (2.2 cm - 8.1 cm)). The clinical data, radiological findings, surgical records and outcome of patients were retrospectively analyzed, and the prognostic factors were analyzed by using of the unpaired χ2 test with continuity correction. Results: Apparent complete tumor removal was achieved in 41 patients (91.1%). Four patients (8.9%) had minimal residual tumors, 3 of which had gamma knife radiosurgery. There was no surgical mortality. The main operative complications included new anosmia (9 cases), intracranial infection (3 cases), frontal contusion (5 cases), frontal mental changes (3 cases), cerebrospinal fluid leakage (2 cases), and visual deficits\brain swelling\seizures and hydrocephalus (1 case) respectively. At 3 - 6 months after discharge, 38 (84.4%) patients had a good recovery, 6 (13.3%) were moderately disabled and 1 (2.2%) was severely disabled. The preoperative KPS ≤ 70 was the cause of unfavorable prognosis (χ2 = 5.139, P = 0.023). During the mean follow-up of 42.6 months (range, 3 - 107 months) for 41 patients, the average KPS was 85.2. Tumor recurred in 3 cases, all being treated with gamma knife radiosurgery, one of which required reoperation. Conclusion: By using optimal operative techniques, OGMs can be removed safely via the unilateral subfrontal approach with relatively low morbidity. The preoperative KPS ≤ 70 is an unfavorable prognostic factor for OGM resection.

Microsurgical Excision of Olfactory Groove Meningeomas, Comparative Studies of Different Surgical Approaches

To review the surgical approaches, techniques, outcomes, and recurrence rates in a series of 6 olfactory groove meningioma (OGM) patients operated from January 2010 to April 2011.Methods: Six patients underwent craniotomy and micro-neurosurgical removal of olfactory groove meningioma maximum. Tumor diameter varied from 5 to 8.5 cm among six cases, 2 cases underwent glabellar mini craniotomy another 2 by bifrontal approach and rest of them were by frontolateral approach. Result: Total removal was possible in all cases. Histopathology revealed typical meningioma (WHO grade 1). there was no operative mortality and no permanent focal neurological deficit except anosmia. One patient developed leak and two cases meningitis which was resolved by lumber drain and antibiotic therapy. No tumor recurrence within six months of followup. For the removal of large olfactory groove meningiomas we used three different surgical approaches: frontolateral approaches, bifrontal approach and glabellar mini craniotomy. We consider the frontolateral approach is an alternative, if not superior, to standard bifrontal approaches. DOI: http://dx.doi.org/10.3329/medtoday.v24i1.13942 Medicine TODAY Vol.24(1) 2012 pp.5-7

The Role of the Pterional Approach in the Surgical Treatment of Olfactory Groove Meningiomas: A 20-year Experience

Background Olfactory groove meningiomas remain surgically challenging. The common microsurgical approaches suffer from late exposure of the neurovascular structures. Conversely, the pterional approach has the advantage of early dissection of the posterior neurovascular complex. Methods We reviewed the records of patients treated for olfactory groove meningioma in our department between 1991 and 2010. A total of 61 patients underwent removal of olfactory groove meningiomas via the pterional approach. These included 58 primary and 3 recurrent tumors. Mean overall follow-up time was 122 months. Results Early exposure and dissection of the internal carotid artery, middle cerebral artery, anterior cerebral artery, and optic nerve was feasible in all cases. Complete tumor removal was achieved in 60 patients. Morbidity and mortality rates were 26% and 1.6% respectively. Postoperative complications included epileptic seizures (five patients) and cerebrospinal fluid (CSF) leak (two patients). During follow-up, we recorded three tumor recurrences. Conclusions The pterional approach appears to be an excellent solution for the treatment of olfactory groove meningiomas. Its foremost advantage is early visualization of the posterior neurovascular complex. Moreover, it allows frontal sinus preservation and timely tumor devascularization and avoids excessive brain retraction. The pterional view is familiar to most neurosurgeons and therefore the transition to this technique is fairly straightforward.

MRI FLAIR Changes in Total Resection of Olfactory Groove Meningiomas through Expanded Endonasal Endoscopic Approaches

Background: olfactory groove meningiomas can grow insidiously and significantly compress the adjacent cerebral structures. One of the main challenges in their surgical management is achieving complete removal without further damage to the frontal lobes. Objective: The purpose of this study is to analyze and describe cerebral edema and FLAIR signal changes in MR imaging of olfactory groove meningiomas totally resected through EEA. Methods: Pre- and postoperative films of 20 consecutive olfactory groove meningiomas completely removed through EEA were reviewed. Tumor volume as well as pre- and postoperative FLAIR signal change volumes, was assessed using the DICOM image viewer OsiriX. Results: Mean tumor volume was 26.2 cm3 (±22.7), mean preoperative FLAIR change volume was 39.1 cm3 (±44.9), and mean postoperative FLAIR change volume was 4.2 cm3 (±5.9). In1 of the 20 cases analyzed (5%) there was increase of signal changes postoperatively, all other patients demonstrated image improvement. Conclusions: EEA appears to be a safe and effective method for total removal of olfactory groove meningiomas. FLAIR signal changes tend to resolve after tumor resection and do not seem to worsen with this operative technique. Further comparative studies are necessary to determine whether this feature differs from open approaches.

Surgical nuances for removal of olfactory groove meningiomas using the endoscopic endonasal transcribriform approach

Olfactory groove meningiomas represent 10% of intracranial meningiomas and arise in the midline of the anterior cranial fossa along the dura of the cribriform plate and planum sphenoidale. Hyperostosis of the adjacent underlying bone is common, and further extension into ethmoid sinuses and nasal cavity can occur in 15%-25% of cases. Radical tumor resection including the involved dural attachment and underlying hyperostotic bone offers the best chance of a Simpson Grade I resection to minimize recurrence. Incomplete removal of involved hyperostotic bone can result in tumor recurrence at the cribriform plate with extension into the paranasal sinuses. Resection has traditionally been performed using a bifrontal or pterional approach, both of which require some degree of brain retraction or manipulation to expose the tumor. The endoscopic endonasal transcribriform approach offers the most direct and immediate exposure to the tumor without brain retraction and manipulation of neurovascular structures. An endonasal "keyhole craniectomy" is performed in the ventral skull base directly over the basal dural attachment, extending from the posterior wall of the frontal sinus to the planum sphenoidale and tuberculum sellae in the anteroposterior plane, and from one medial orbit to the other in the coronal plane. Excellent panoramic visualization of the keyhole skull base defect can be obtained with a 30° endoscope after performing a modified Lothrop procedure. Because the dural attachment is adjacent to the paranasal sinuses, early devascularization and total Simpson Grade I removal of the tumor including the dural attachment and underlying hyperostotic bone can be achieved in properly selected patients. This approach is also very suitable for meningiomas that have recurred or extended into the paranasal sinuses. Extracapsular, extraarachnoid dissection of the tumor from the frontal lobes and neurovascular structures can be performed using conventional bimanual microsurgical techniques. In this report, we review the surgical technique and describe our operative nuances for removal of olfactory groove meningiomas, including recurrent tumors with extension into the nasal cavity, using a purely endoscopic endonasal transcribriform approach. In addition, we discuss the advantages, limitations, patient selection, and complications of this approach. We specifically highlight our technique for multilayer reconstruction of large anterior skull base dural defects using fascia lata and acellular dermal allograft supplemented by bilateral vascularized pedicled nasoseptal flaps. Three new cases of endoscopically resected olfactory groove meningiomas are also presented.

Meningiomas del surco olfatorio. Tratamiento microquirúrgico radical por vía bifrontal

To describe the microsurgical technique for the radical removal of olfactory groove meningiomas through the bifrontal approach. To review the diagnostic elements to be taken into account in the selection of the surgical approach to these tumours. A microsurgical series of 35 olfactory groove meningiomas operated on through a bifrontal craniotomy is reviewed. The mean tumoral volume was 85cc (4.4cm diameter). A relevant peritumoral brain edema was found in 65.7% of cases, hyperostosis in the implantation base in 80% and paranasal sinus invasion in 28.6%. A Sipmson grade 1 resection was achieved in every case. A patient died due to a postoperative pneumonia. Postoperative hospitalization time was between 3 and 20 days and at discharge all patients had a Glasgow Outcome Scale grade 4-5. The mean follow-up was 55.2 months. Two patients had postoperative transient rhinolicuorrhea and an additional patient developed hydrocephalus. An asymptomatic recurrence have been identified in a patient four years after surgery. In our experience the bifrontal approach allowed the radical removal of huge olfactory groove meningiomas. The microdissection of the anterior cerebral artery A2 segments is possible thanks to the arachnoidal plane between vessels and tumor. Tumoral blood flow is secured by the early approaching of the base of the tumor and preoperative embolization is not necessary. Bifrontal approach allows an aggressive treatment of the hyperostosis, bone infiltration and paranasal sinus invasion. Anterior fossa reconstruction is done using a vascularized periosteal flap.

Unilateral frontal interhemispheric transfalcial approaches for the removal of olfactory groove meningiomas

A unilateral subfrontal interhemispheric transfalcial approach for the removal of olfactory groove meningiomas (OGM) was evaluated in terms of surgical technique, complications, clinical outcomes, and recurrence rate. Twenty-four females and eighteen males with a mean age of 59 years were operated on for OGM within a 12- year (1996-2008) period. The pre- and post-operative Mini-Mental Test (MMT) scores, visual impairment scores (VIS), pre-operative clinical symptoms (headache, epileptic seizure and anosmia), Karnofsky performance scores (KPS), tumor size and tumor extensions were evaluated. The effects of the pre-operative parameters on post-operative MMT, VIS and KPS were investigated. Tumor size and pre-operative MMT significantly affected pre-operative KPS. Mean tumor diameter was 5.6±0.8 cm. Total excision was achieved in 97.6% of all cases. No peri-operative mortality was seen. Ten patients (23.8%) experienced surgery-related complications. The mean follow-up period of cases was 52 months, and the rate of residual tumor re-growth was 2.3%. No parameter showed any effect on post-operative KPS, as no significant difference was seen between pre- and post-operative KPS. A significant positive difference was detected between pre- and post-operative MMT and VIS. A unilateral subfrontal interhemispheric transfalcial approach can be the preferred modality for treating OGM.

The pterional approach for the microsurgical removal of olfactory groove meningiomas.

Currently, the surgical approach to olfactory meningiomas can vary depending on the size and expansion of the tumor, although surgical treatment still relies on the anterior bilateral craniotomy. Since 1989, we have use the pterional approach as a standard procedure in the treatment of 37 consecutive cases. We present our results in an attempt to contribute an alternative and valid surgical strategy for the treatment of these tumors. Between 1989 and 1996, a series of 37 consecutive patients underwent microsurgical tumor resection using the unilateral pterional approach; all patients except one underwent operations on the right side. In 23 patients (62%), the tumor diameter measured approximately 6 cm, and the size was less than 4 cm in only 5 patients. The clinical presentation included mental dysfunction in 27 patients and visual impairment in 16 patients. The advantages of this approach are the early recognition of the posterior cerebrovascular complex, followed by a safe, rapid, and complete devascularization of the tumor and later by a favorable dissection of the capsular area from the frontal vascular branches and parenchyma. Total removal was achieved in all cases. There was one death unrelated to surgery. All patients presenting with mental dysfunction or with preoperative visual deficits recovered or improved. Postoperative magnetic resonance imaging confirmed complete tumor removal and demonstrated the brain parenchyma to be preserved and intact, primarily on the side opposite from the craniotomy. Our experience with the pterional approach suggests a greater role for this procedure in the treatment of olfactory groove meningiomas.

Interhemispheric approach for microsurgical removal of olfactory groove meningiomas.

Eighteen consecutive patients with olfactory groove meningiomas, with diameters ranging from 1.5 to 7 cm, underwent microsurgical tumour resection using a unilateral frontal interhemispheric approach. Unilateral frontal craniotomy, superior to the frontal sinus, exposing the superior sagittal sinus was performed. The ipsilateral frontal lobe was gently retracted laterally, and the tumour resected through the gap between the falx and the medial aspect of the frontal lobe, anteriorly to the genu of the corpus callosum. Gross total tumour resection was achieved in all the patients. There was no evidence of damage to the frontal lobes, the anterior cerebral arteries or the optic system. Compared with the more commonly applied subfrontal route, the interhemispheric approach has the advantages of sparing the frontal sinuses and providing excellent overview of the dissection of the anterior cerebral arteries and the optic system, as well as for the resection of tumour invading the frontal cranial base.

Microsurgical Removal of Olfactory Groove Meningiomas via the Pterional Approach

Commonly used frontobasal approaches for microsurgical removal of olfactory groove meningiomas have certain disadvantages, such as late exposure of the neurovascular complex located dorsal to the tumor, namely, the internal carotid artery, middle cerebral artery, anterior cerebral artery, and the optic nerves. In addition, the frontal sinuses are frequently opened and there can be compression of the frontal lobes from significant spatula pressure. We report our experience with the pterional approach for these tumors in 28 patients. All patients presented with hyposmia/anosmia; 20 had personality changes and 8 had visual deficits. At surgery, after dissection of the sylvian fissure, the internal carotid artery, middle cerebral artery, anterior cerebral artery, and the homolateral optic nerve were exposed before removal of the posterior tumor parts. Reduction of focal pressure was achieved by removal of the contralateral tumor following partial resection of the falx and crista galli. Total tumor removal was obtained in all but 1 patient. One patient died of pulmonary embolism. The psychoorganic syndrome resolved in all but 1 patient; visual deficits improved in 6 patients. There were no postoperative infections. We consider the pterional approach to be superior to others for these lesions because it provides early exposure of the neurovascular complex, preservation of the frontal venous drainage, and avoidance of postoperative cerebrospinal fluid fistulae.