Treatment of Olfactory Groove Meningioma through a Unilateral Subfrontal Approach / 中国医科大学学报

Objective To compare the operative results of removing large olfactory groove meningiomas(diameter≥3 cm)using either a unilat?eral or bilateral subfrontal approach ,and to determine whether there is an advantage in the unilateral approach. Methods Sixty?nine cases of large olfactory groove meningioma,treated in our department,by either a unilateral or bilateral subfrontal approach microsurgery were retrospec?tively reviewed. Removal grading,post?operative complications,and other clinical indices were evaluated. Results Total resection(Simpson Ⅰ or Ⅱ)was achieved in all the cases. There were lesser complications with use of the unilateral subfrontal approach. Conclusion Patients with ol?factory groove meningioma have a good prognosis when a unilateral subfrontal approach is used for surgery.

A Case of Bilateral Visual Loss due to an Olfactory Groove Meningioma

PURPOSE: To describe a case of severe bilateral visual loss in a patient with olfactory groove meningioma. CASE SUMMARY: A 64-year-old man presented with a 1-year history of anosmia, progressive loss of vision and visual field deficit. Presenting visual acuity was Counting fingers at 10 cm, and visual field exam showed total visual field defect in both eyes, but there was no remarkable finding to warrant an ophthalmologic examination except mild nucleosclerosis in both eyes and temporal pallor in the left optic nerve head. A brain MRI scan was performed and revealed an olfactory groove meningioma. Surgical resection was performed, and pathologic findings showed meningotheliomatous meningioma. Two months later, the patient was healthy, but no significant improvement of visual acuity or visual field was observed. CONCLUSIONS: In patients with unexplained visual loss with anosmia, olfactory groove meningioma should be considered.

Postoperative Brain Swelling after Resection of Olfactory Groove Meningiomas

OBJECTIVE: Postoperative brain swelling after resection of olfactory groove meningiomas by bifrontal interhemispheric transbasal approach is a knotty subject. Pathogenesis and predictive factors were investigated to prevent the problem. METHODS: Eighteen patients of olfactory groove meningiomas who had undergone surgery were enrolled and retrospectively analyzed using their clinical and radiological data. Bifrontal interhemispheric transbasal approach was used in all patients. Magnetic resonance imaging and transfemoral cerebral angiography were available for investigation in 18 and 14 patients respectively. Postoperative clinical course, tumor volume, peritumoral edema, tumor supplying vessels, and venous drainage patterns were carefully investigated in relation to postoperative brain swelling. RESULTS: Seven patients (39%) developed clinically overt brain swelling after surgery. Among them, 4 patients had to undergo decompression surgery. In three patients, attempted bone flap removal was done by way of prevention of increased intracranial pressure resulted from intractable brain swelling and two of them eventually developed brain swelling which could be recovered without sequellae. Abnormal frontal base venous channel observed in preoperative angiography was significant predictive factor for postoperative brain swelling (p=0.031). However, tumor volume, peritumoral edema, and existence of pial tumor supplying vessels from anterior cerebral arteries were failed to show statistical significances. CONCLUSION: To prevent postoperative brain swelling in olfactory groove meningioma surgery, unilateral approach to preserve frontal base venous channels or temporary bone flap removal is recommended when it is indicated.

Neuroendoscope-assisted Microneurosurgery via Supraorbital Keyhole Approach for Giant Olfactory Groove Meningioma / 中国微创外科杂志

Objective To explore the effect and technical skills of neruoendoscope-assisted microneurosurgery via the supraorbital keyhole apporach for giant olfactory groove meningiomas.Methods A total of 12 patients with giant olfactory groove meningiomas(≥7 cm in diameter)received neruoendoscope-assisted microneurosurgery via the supraorbital keyhole approach.Data of the patients were analyzed retrospectively.Results Among the cases,9 achieved complete resection of the tumor,inlcuding 5 cases of SimpsonⅠ and 4 cases of Simpson Ⅱ.The other 3(Simpson Ⅲ)patients underwent subtotal resection.None of the patients died during the operation.Ten of the patients were follwed up for 3 months to 2 years(mean,14 months).During the follow-up,9 of the 10 resumed physical and sporting activities,and the other one retured to normal daily life.MRI examination was prefomred on 9 patients,none of them had recurrence.Conclusions Neruoendoscope-assisted microneurosurgery via the supraorbital keyhole approach is effective and safe for patient with giant olfactory groove meningioma.The tumor should be removed piece by piece during the operation.