Magnetic resonance imaging fluid-attenuated inversion recovery sequence signal reduction after endoscopic endonasal transcribiform total resection of olfactory groove meningiomas

Abstract

Background:Olfactory groove meningiomas grow insidiously and compress adjacent cerebral structures. Achieving complete removal without further damage to frontal lobes can be difficult. Microsurgical removal of large lesions is a challenging procedure and usually involves some brain retraction. The endoscopic endonasal approaches (EEAs) for tumors arising from the anterior fossa have been well described; however, their effect on the adjacent brain tissue has not. Herein, the authors utilized the magnetic resonance imaging fluid attenuated inversion recovery (FLAIR) sequence signal as a marker for edema and gliosis on pre- and post-operative images of olfactory groove meningiomas, thus presenting an objective parameter for brain injury after surgical manipulation.Methods:Imaging of 18 olfactory groove meningiomas removed through EEAs was reviewed. Tumor and pre/postoperative FLAIR signal volumes were assessed utilizing the DICOM image viewer OsiriX®. Inclusion criteria were: (1) No previous treatment; (2) EEA gross total removal; (3) no further treatment.Results:There were 14 females and 4 males; the average age was 53.8 years (±8.85 years). Average tumor volume was 24.75 cm3 (±23.26 cm3, range 2.8–75.7 cm3), average preoperative FLAIR volume 31.17 cm3 (±39.38 cm3, range 0–127.5 cm3) and average postoperative change volume, 4.16 cm3 (±6.18 cm3, range 0–22.2 cm3). Average time of postoperative scanning was 6 months (range 0.14–20 months). In all cases (100%) gross total tumor removal was achieved. Nine patients (50%) had no postoperative FLAIR changes. In 2 patients (9%) there was minimal increase of changes postoperatively (2.2 cm3 and 6 cm3 respectively); all others demonstrated image improvement. The most common complication was postoperative cerebrospinal fluid leakage (27.8%); 1 patient (5.5%) died due to systemic complications and pulmonary sepsis.Conclusions:FLAIR signal changes tend to resolve after endonasal tumor resection and do not seem to worsen with this operative technique.

Surgical Resectability of Skull Base Meningiomas

“… 3 , 5 , 7) Several groups have preferred to select endoscopic approaches to lesions through a frontal key hole window or transnasal corridors to decrease frontal lobe retraction. 8 – 10) Surgical resectability of this approach is also acceptable, but endoscopic approaches cannot be applied to tumors more than 40 mm in diameter, calcification, or absence of a cortical vascular cuff. 10 , 11) The resectability of olfactory groove meningiomas is shown in Table 1 .…”

Serial lumbar puncture reduces cerebrospinal fluid (CSF) infection during removal of hemorrhagic CSF in aneurysmal subarachnoid hemorrhage after endovascular coiling

“…In the present study, 6 patients in the LD group (15.38%) suffered from CSF infection, 4 of whom (10.26%) were confirmed by CSF culture and the rate was similar to that reported previously. Some researchers considered LD as a significant risk factor for meningo-ventriculitis [ 17 ] . As the risk of LD associated CSF infection was complicated, the patients with long term duration of catheter placement (more than 4 days) or with puncture site leakage are at greater risk [ 18 ] .…”

The Role of 3D Tractography in Skull Base Surgery: Technological Advances, Feasibility, and Early Clinical Assessment with Anterior Skull Base Meningiomas

“…Patients were excluded from the study if: (1) management did not include all components of our current clinical and technological platform (inception in April 2015), (2) surgical management required early termination (e.g., for sinonasal cavity infection precluding opening the dura), or (3) either pre-or postoperative DTI was lacking for the purposes of tract recovery determination. Medical records, including imaging, were analyzed and the following data were recorded: (1) age, (2) gender, (3) tumor location within the skull base, (4) history of previous resection/surgery, (5) history of previous pre-operative radiation use, (6) surgical approach, (7) total operative time (from incision to closing), (8) intraoperative blood loss, (9) extent of resection (EOR): the difference between pre-and postoperative tumor volume (cm 3 ), (10) postoperative complications, and (11) pre-and postoperative CN deficits, and degree of recovery at short-term follow-up.…”

“…We have previously evaluated T2-fluid-attenuated inversion recovery (T2-FLAIR) sequence signal abnormality on magnetic resonance imaging (MRI) following endoscopic endonasal approach (EEA) resection of olfactory groove (OG) meningiomas. 8 We postulated that pre-and postoperative FLAIR changes could be an objective measure of the degree of edema and gliosis preoperatively and the extent of brain injury following surgical resection. While that study investigated solely endonasal approaches, it provided the foundation for analyzing surgical performance and revising our decision-making algorithm in skull base approaches.…”