The Olfactory Nerve: Anatomy and Pathology.

The human sense of smell is the unique sense through which the olfactory system can identify aromatic molecules within the air and provide a taste sensation. Still, also it plays an essential role in several other functions, warning about environmental safety and even impacts our emotional lives. Recently, olfactory impairment has become an issue of interest due to the COVID-19 pandemic. The dysfunction may vary from only reduced smell detection (hyposmia) to complete loss of it (anosmia) but also includes changes in the normal perception of odors (parosmia). Computed tomography and magnetic imaging resonance are the modalities of choice to evaluate the olfactory pathways. Computed tomography is the initial imaging modality for olfactory disturbances, allowing recognition of sinonasal pathologies, inflammatory processes, or bone-related tumors. Magnetic imaging resonance with dedicated protocols for olfactory disorders enables a detailed assessment of the sinonasal compartment and the anterior cranial fossa. Provides a better depiction of olfactory bulb volume, morphology and signal intensity, as well the status of signal intensity of the central olfactory projection areas. Several diseases can affect the olfactory nerve, such as congenital disorders, trauma, inflammatory or infectious diseases, neoplasms, and even post-operative involvement. This article aims to review the normal anatomy of the olfactory nerve pathway and highlight the spectrum of conditions that most commonly affect it.

Olfactory nerve sparing technique for anterior skull base meningiomas: how I do it.

BACKGROUND: Olfactory function preservation is a desirable objective in anterior skull base (ASB) surgery. The "infracerebral-supraolfactory nerve" corridor is presented. METHOD: The technique for preserving the olfactory nerves (OlfNs) in anterior ASB meningioma removal involves the following points: deep knowledge of the ASB vascular and meningeal anatomy, precise preoperative planning, wide and sharp dissection of the OlfNs away from the frontal lobes, gravity-aided frontal lobe retraction, Gelfoam-assisted hemostasis on nervous structures, and access to the lesion through an infracerebral-supraolfactory nerve corridor. CONCLUSIONS: This technique may be a valid option for patients affected by anterior skull base meningiomas with intact preoperative olfactory function.

Diagnostic Accuracy of MRI-Based Morphometric Parameters for Detecting Olfactory Nerve Dysfunction.

BACKGROUND AND PURPOSE: Although olfactory dysfunction is a common cranial nerve disorder, there are no simple objective morphometric criteria to assess olfactory dysfunction. The aim of this study was to evaluate the diagnostic performance of MR imaging morphometric parameters for detecting olfactory dysfunction. MATERIALS AND METHODS: This prospective study enrolled patients from those presenting with olfactory symptoms who underwent both an olfactory function test and MR imaging. Controls without olfactory dysfunction were recruited during the preoperative work-up for pituitary adenoma. Two independent neuroradiologists measured the olfactory bulb in 3D and assessed olfactory bulb concavity on MR imaging while blinded to the clinical data. Diagnostic performance was assessed using receiver operating characteristic curve analysis. RESULTS: Sixty-four patients and 34 controls were enrolled. The patients were significantly older than the controls (mean age, 57.8 ± 11.9 years versus 47.1 ± 12.1 years; P < .001). Before age adjustment, the olfactory bulb height was the only olfactory bulb parameter showing a significant difference between patients and controls (1.6 ± 0.3 mm versus 2.0 ± 0.3 mm, P < .001). After age adjustment, all parameters and olfactory bulb concavity showed significant intergroup differences, with the olfactory bulb height having the highest area under the curve (0.85). Olfactory bulb height was confirmed to be the only significant parameter showing a difference in the detection of olfactory dysfunction in 22 pairs after matching for age and sex (area under the curve = 0.87, P < .001). Intraclass correlation coefficients revealed moderate-to-excellent degrees of inter- and intrareader agreement. CONCLUSIONS: MR imaging morphometric analysis can differentiate patients with olfactory dysfunction, with the olfactory bulb height having the highest diagnostic performance for detecting olfactory dysfunction irrespective of age.

Nasal thallium-201 uptake in patients with parosmia with and without hyposmia after upper respiratory tract infection.

BACKGROUND: In this study, we aimed to determine whether nasal thallium-201 uptake of the olfactory cleft and olfactory bulb (OB) differs between patients with parosmia with and without hyposmia after upper respiratory tract infection (URTI). METHODS: Twenty patients with parosmia after URTI were enrolled in this study (15 women and 5 men, 28 to 76 years old). Nasally administered thallium-201 migration to the OB, nasal thallium-201 uptake ratio in the olfactory cleft, and OB volume were determined in 10 patients with normal T&T olfactometry (Daiichi Yakuhin Sangyo, Tokyo, Japan) odor recognition thresholds (≤2.0) who still complained of parosmia (parosmia group), and 10 patients with T&T odor recognition thresholds >2.0 (parosmia and hyposmia group). RESULTS: The nasal thallium-201 uptake ratio in the olfactory cleft was significantly higher in the parosmia group than in the parosmia and hyposmia group (p = 0.0015). Thallium-201 migration to the OB was not significantly different between the 2 groups (p = 0.31). The OB volume was significantly larger in the parosmia group than that in the parosmia and hyposmia group (p = 0.029); however, the mean OB volume in both the groups was lower than the normal threshold value in healthy individuals. CONCLUSION: Our results signify the recovery of the olfactory epithelium; however, the olfactory neural projections to the OB and regeneration of OB were not complete in patients with parosmia with normal T&T recognition thresholds after URTI.

Prognostic value of olfactory nerve damage measured with thallium-based olfactory imaging in patients with idiopathic olfactory dysfunction.

Idiopathic olfactory disorder is resistant to treatment, and the recovery time is long. This study investigated the prognostic value of the migration of nasally administered thallium-201 to the olfactory bulb (thallium migration to the OB), a measure of olfactory nerve damage, in patients with idiopathic olfactory disorders. Twenty-four patients with idiopathic olfactory disorders were enrolled in the study (7 women and 17 men; aged 23-73 years). We retrospectively analyzed potential prognostic markers in subjects who underwent thallium-based olfactory imaging with the nasal administration of thallium-201 before conventional treatment with the Japanese herbal medicine tokishakuyakusan and compared those data with the prognosis. Log-rank tests were performed to assess the relationship between thallium migration to the OB (<4.6% [low] vs. ≥4.6% [high]; data dichotomized at the optimal cutoff value) and the duration until recovery of the odor recognition threshold determined by a standard olfactory function test (T&T olfactometry) after the treatment. Upon statistical analysis, we found that high thallium migration to the OB was significantly correlated with better prognosis in patients. Our results suggest that patients with intact olfactory nerve fibers could be selected using thallium-based imaging for the long-term follow-up of olfactory dysfunction.

Nasal neuron PET imaging quantifies neuron generation and degeneration.

Olfactory dysfunction is broadly associated with neurodevelopmental and neurodegenerative diseases and predicts increased mortality rates in healthy individuals. Conventional measurements of olfactory health assess odor processing pathways within the brain and provide a limited understanding of primary odor detection. Quantification of the olfactory sensory neurons (OSNs), which detect odors within the nasal cavity, would provide insight into the etiology of olfactory dysfunction associated with disease and mortality. Notably, OSNs are continually replenished by adult neurogenesis in mammals, including humans, so OSN measurements are primed to provide specialized insights into neurological disease. Here, we have evaluated a PET radiotracer, [11C]GV1-57, that specifically binds mature OSNs and quantifies the mature OSN population in vivo. [11C]GV1-57 monitored native OSN population dynamics in rodents, detecting OSN generation during postnatal development and aging-associated neurodegeneration. [11C]GV1-57 additionally measured rates of neuron regeneration after acute injury and early-stage OSN deficits in a rodent tauopathy model of neurodegenerative disease. Preliminary assessment in nonhuman primates suggested maintained uptake and saturable binding of [18F]GV1-57 in primate nasal epithelium, supporting its translational potential. Future applications for GV1-57 include monitoring additional diseases or conditions associated with olfactory dysregulation, including cognitive decline, as well as monitoring effects of neuroregenerative or neuroprotective therapeutics.

Visualization of the olfactory nerve using constructive interference in steady state magnetic resonance imaging.

PURPOSE: The olfactory nerve (OlfN) is a small neural structure with inconsistent visualization on neuroimages. The aim of this study was to delineate the intracranial course of the OlfN using constructive interference in steady state magnetic resonance (MR) imaging. METHODS: A total of 168 patients were enrolled in this study. Following initial examinations with conventional MR sequences, constructive interference in steady-state sequence (CISS) was performed in coronal and axial sections. RESULTS: On coronal sections, the OlfN was entirely visualized in 90 % of patients on the right and 92 % on the left, coursing along the olfactory sulcus. Complete visualization of the OlfN occurred in 100 % of patients on serial axial images. The OlfN was classified into four portions based on the topographical differences and surrounding structures. The olfactory fossa exhibited considerable variability at the midlevel of the olfactory bulb on coronal images. Characteristic appearance of the OlfN with respect to age range or gender was not observed. CONCLUSIONS: The OlfN follows a highly consistent course along the olfactory sulcus. Thin-sliced, CISS sequences are useful for consistent visualization of the OlfN.

Assessment of olfactory nerve by SPECT-MRI image with nasal thallium-201 administration in patients with olfactory impairments in comparison to healthy volunteers.

PURPOSE: The aim of this study was to assess whether migration of thallium-201 ((201)Tl) to the olfactory bulb were reduced in patients with olfactory impairments in comparison to healthy volunteers after nasal administration of (201)Tl. PROCEDURES: 10 healthy volunteers and 21 patients enrolled in the study (19 males and 12 females; 26-71 years old). The causes of olfactory dysfunction in the patients were head trauma (n = 7), upper respiratory tract infection (n = 7), and chronic rhinosinusitis (n = 7). (201)TlCl was administered unilaterally to the olfactory cleft, and SPECT-CT was conducted 24 h later. Separate MRI images were merged with the SPECT images. (201)Tl olfactory migration was also correlated with the volume of the olfactory bulb determined from MRI images, as well as with odor recognition thresholds measured by using T&T olfactometry. RESULTS: Nasal (201)Tl migration to the olfactory bulb was significantly lower in the olfactory-impaired patients than in healthy volunteers. The migration of (201)Tl to the olfactory bulb was significantly correlated with odor recognition thresholds obtained with T&T olfactometry and correlated with the volume of the olfactory bulb determined from MRI images when all subjects were included. CONCLUSIONS: Assessment of the (201)Tl migration to the olfactory bulb was the new method for the evaluation of the olfactory nerve connectivity in patients with impaired olfaction.

Evaluation of the olfactory nerve transport function by SPECT-MRI fusion image with nasal thallium-201 administration.

PURPOSE: The aim of this study was to visualize the human olfactory transport pathway to the brain by performing imaging after nasal thallium-201 ((201)Tl) administration. PROCEDURES: Healthy volunteers were enrolled in this study after giving informed consent (five males, 35-51 years old). The subjects were nasally administered (201)TlCl into either the olfactory cleft. Twenty-four hours later, uptake of (201)Tl was detected by a single photon emission computed tomography (SPECT)/X-ray computed tomography hybrid system. For each subject, an MRI image was obtained and merged with the SPECT image. RESULTS: The peak of the (201)Tl uptake entered into the olfactory bulb in the anterior skull base through the cribriform lamina 24 h after nasal administration of (201)Tl. No participant had olfactory disturbance after treatment. CONCLUSIONS: Nasal (201)Tl administration was safely used to assess the direct pathway to the brain via the nose in healthy volunteers with normal olfactory threshold.

Imaging the olfactory tract (cranial nerve #1).

This review paper browses pros and cons of the different radiological modalities for imaging the olfactory tract and highlights the potential benefits and limitation of more recent advances in MR and CT technology. A systematic pictorial overview of pathological conditions affecting olfactory sense is given. Techniques for collecting quantitative data on olfactory bulb volume and on olfactory sulcus depth are described. At last, insights into functional imaging of olfactory sense are shown.

Tracing neural pathways in snail olfaction: from the tip of the tentacles to the brain and beyond.

The anatomical organization of the olfactory system of terrestrial snails and slugs is described in this paper, primarily on the basis of experiments using the African snail Achatina fulica. Behavioral studies demonstrate the functional competence of olfaction in mediating food finding, conspecific attraction, and homing. The neural substrate for olfaction is characterized by an extraordinarily large number of neurons relative to the rest of the nervous system, and by the fact that many of them are unusually small. There exist multiple serial and parallel pathways connecting the olfactory organ, located at the tip of the tentacle, with integrative centers in the central nervous system. Our methods of studying these pathways have relied on the selective neural labels horseradish peroxidase and hexamminecobaltous chloride. One afferent pathway contains synaptic glomeruli whose ultrastructure is similar to that of the glomeruli seen in the mammalian olfactory bulb and the insect olfactory lobe. All of the olfactory neuropils, but especially the tentacle ganglion, contain large numbers of morphologically symmetrical chemical synapses. The procerebrum is a unique region of the snail brain that possesses further features analogous with olfactory areas in other animal groups. Olfactory axons from the tentacle terminate in the procerebrum, but the intrinsic neurons do not project outside of it. An output pathway from the procerebrum to the pedal ganglion has been identified and found to consist of inter-ganglionic dendrites. The major challenge for future studies is to elucidate the pattern of connectivity within, rather than between, the various olfactory neuropils.

[Olfactory neuroblastoma--tumor entity or complex clinical picture?]. / Das Olfaktoriusneuroblastom--Tumorentität oder klinischer Formenkreis?

Clinical and radiological findings in seven cases of olfactory neuroblastoma are reviewed and discussed in the light of the international literature. The report provides further evidence of difficulties related to the predictability of the condition's clinical course, diagnosis, and therapeutic consequences. Moreover, the lack of uniform CCT and NMR features indicates that the discussion about the genesis, the biological action, the terminology, and therapy of these tumors has not yet reached a conclusion.

Extradural nasal and orbital extension of malignant glioma. Case report.

A rare case of extradural nasal and orbital extension of malignant glioma is presented. The development of malignant changes was observed during 10 years. The mode of transdural extension was via the olfactory nerve, where it was directly destructive in all four cases that have been reported to date. The biological malignancy of transdurally extending glioma is also described.

[A case of basal encephalomeningocele (a transethmoidal type) containing the olfactory nerve].

An experience of operative case of basal (transethmoidal type) encephalomeningocele is reported. A 3-year-old boy complained of continuous, spontaneous cerebrospinal fluid rhinorrhea and right intranasal mass lesion. The rhinorrhea began when one year old. He suffered from meningitis at the age of two. When he was three years old, the intranasal mass and CSF rhinorrhea were perceived. On admission he had normal general status and no abnormality in neurological examination. The usual axial computed tomography showed a small mass in the intranasal cavity. But the continuity between the mass and brain parenchyma was not detected in this study. Metrizamide CT cisternography demonstrated it. Coronal CT scan visualized it more directly. We performed operation using bifrontal craniotomy and subfrontal approach. Brain parenchyma did not protrude into the frontal cranial base and expanding right olfactory nerve penetrated into the small defect at the right cribriform plate. The olfactory nerve was extracted as much as possible. The defect was filled with a few piece of muscle and coating with the adhesive agent was performed. Histological findings of operative specimen were abnormal olfactory nerve, normal brain tissue and arachnoid membrane. Post-operative state was uneventful. CSF rhinorrhea disappeared. Post-operative direct sagittal computed tomography visualized the encephalomeningocele extremely. Biopsy of the intranasal mass revealed brain tissue covered by normal nasal epithelium. Basal encephalocele is rare in Japan. We found 10 cases in the literature. It is important that we do not forget basal encephalocele in the difference of intranasal tumors.(ABSTRACT TRUNCATED AT 250 WORDS)

Experimental in vivo imaging of the cranial perineural lymphatic pathway.

After intraventricular injection of 99mTc antimony sulfide in rabbits (n = 12) and cats (n = 14), radiolabeled colloid was imaged passing into the nasal mucosa and subsequently into the cervical lymph nodes. The cervical lymph nodes accounted for about 12% of the injected dose in rabbits sacrificed at 22-24 hr after injection and about 5% of the injected dose in cats sacrificed at 5-6 hr after injection. In both animals this represented at least one-third of the cerebrospinal fluid colloid clearance. This technique is applicable to in vivo imaging studies of the perineural lymphatic pathway for cerebrospinal fluid absorption in primates and, with modifications, in human subjects.