[Olfactory groove meningiomas. Radical microsurgical treatment through the bifrontal approach]. / Meningiomas del surco olfatorio. Tratamiento microquirúrgico radical por via bifrontal.

OBJECTIVES: 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. MATERIALS AND METHODS: A microsurgical series of 35 olfactory groove meningiomas operated on through a bifrontal craniotomy is reviewed. RESULTS: 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. CONCLUSIONS: 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.

Meningiomas del surco olfatorio. Tratamiento microquirúrgico radical por vía bifrontal / Olfactory groove meningiomas. Radical microsurgical treatment through the bifrontal approach

Objetivos. Describir los detalles técnicos del abordajebifrontal para el tratamiento microquirúrgicoradical de los meningiomas del surco olfatorio. Revisarlos factores diagnósticos a valorar en la selección delabordaje quirúrgico de estos tumores.Material y métodos. Se revisa una serie microquirúrgicade 35 tumores del surco olfatorio intervenidospor vía bifrontal.Resultados. El volumen medio de las lesiones era de85 cc (4.4 cm de diámetro). El 65.7% presentaban edemacerebral perilesional relevante, el 80% hiperostosis enla base de implantación y el 28.6% invasión de los senosparanasales. En todos los casos se realizó una exéresisgrado 1 de Simpson. Hubo un éxitus por neumonía. Laestancia hospitalaria fue de 3-20 días, con un GlasgowOutcome Scale 4-5 al alta en todos los casos y seguimientomedio de 55.2 meses. Como complicacionesrelevantes destacan rinolicuorrea transitoria en doscasos e hidrocefalia en otro caso. Se ha identificado unarecidiva local asintomática en un paciente a los 4 años (..) (AU)

Objectives. To describe the microsurgical techniquefor the radical removal of olfactory groove meningiomasthrough the bifrontal approach. To review the diagnosticelements to be taken into account in the selection ofthe surgical approach to these tumours.Materials and methods. A microsurgical series of 35olfactory groove meningiomas operated on through abifrontal craniotomy is reviewed.Results. The mean tumoral volume was 85cc (4.4cmdiameter). A relevant peritumoral brain edema wasfound in 65.7% of cases, hyperostosis in the implantationbase in 80% and paranasal sinus invasion in28.6%. A Sipmson grade 1 resection was achievedin every case. A patient died due to a postoperativepneumonia. Postoperative hospitalization time wasbetween 3 and 20 days and at discharge all patientshad a Glasgow Outcome Scale grade 4-5. The meanfollow-up was 55.2 months. Two patients had postoperativetransient rhinolicuorrhea and an additional (..) (AU)