Olfactory dysfunction after subarachnoid hemorrhage caused by ruptured aneurysms of the anterior communicating artery

Martin, Gemma Escartin; Junqué, Carme; Juncadella, Montserrat; Gabarrós, Andreu; Miquel, Maria Angels de; Rubio, Francisco

doi:10.3171/2008.11.jns08827

Cited by 21 publications

(27 citation statements)

References 24 publications

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“…It has been reported that 12000 – 24000 tons of vanadium per year are generated from the burning of fossil fuels (Bertine and Goldberg, 1971), and given that fossil fuel demand has risen considerably since then (Huntington, 2010), the emission rate attributable to fossil fuel burning has likely risen dramatically. Also, vanadium concentrations have been reported in cigarette smoke to range from 0.49 to 5.33 µg/g (Adachi et al, 1998), and smoking has been linked to olfactory dysfunction (Frye et al, 1990, Martin et al, 2009). …”

Section: Discussionmentioning

confidence: 99%

Vanadium exposure induces olfactory dysfunction in an animal model of metal neurotoxicity

et al. 2014

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Epidemiological evidence indicates chronic environmental exposure to transition metals may play a role in chronic neurodegenerative conditions such as Parkinson’s disease (PD). Chronic inhalation exposure to welding fumes containing metal mixtures may be associated with development of PD. A significant amount of vanadium is present in welding fumes, as vanadium pentoxide (V2O5), and incorporation of vanadium in the production of high strength steel has become more common. Despite the increased vanadium use in recent years, the neurotoxicological effects of this metal are not well characterized. Recently, we demonstrated that V2O5 induces dopaminergic neurotoxicity via protein kinase C delta (PKCδ)-dependent oxidative signaling mechanisms in dopaminergic neuronal cells. Since anosmia (inability to perceive odors) and non-motor deficits are considered to be early symptoms of neurological diseases, in the present study, we examined the effect of V2O5 on the olfactory bulb in animal models. To mimic the inhalation exposure, we intranasally administered C57 black mice a low-dose of 182 µg of V2O5 three times a week for one month, and behavioral, neurochemical and biochemical studies were performed. Our results revealed a significant decrease in olfactory bulb weights, tyrosine hydroxylase (TH) levels, levels of dopamine (DA) and its metabolite, 3, 4-dihydroxyphenylacetic acid (DOPAC) and increases in astroglia of the glomerular layer of the olfactory bulb in the treatment groups relative to vehicle controls. Neurochemical changes were accompanied by impaired olfaction and locomotion. These findings suggest that nasal exposure to V2O5 adversely affects olfactory bulbs, resulting in neurobehavioral and neurochemical impairments. These results expand our understanding of vanadium neurotoxicity in environmentally-linked neurological conditions.

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Section: Discussionmentioning

confidence: 99%

Vanadium exposure induces olfactory dysfunction in an animal model of metal neurotoxicity

et al. 2014

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“…13 Older age has also been identified in several studies as a risk factor to olfaction after surgical clipping of a ruptured aneurysm. 9,13 Similarly, the current authors discovered a higher incidence of olfactory dysfunction after SAH in patients aged ≥ 55 years. 13 Yet, in the present study of patients with unruptured ACoA aneurysms, age did not reach statistical significance as a risk factor.…”

Section: Discussionmentioning

confidence: 81%

Height of aneurysm neck and estimated extent of brain retraction: powerful predictors of olfactory dysfunction after surgery for unruptured anterior communicating artery aneurysms

Park

Son²,

Goh³

et al. 2016

JNS

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A pterionAl approach and its modifications are commonly used for clipping most anterior circulation aneurysms. In such an approach, the frontal lobe and olfactory nerve are both retracted to some degree to access aneurysms located in the circle of Willis. In particular, in cases of an anterior communicating artery (ACoA) aneurysm, a retractor is placed across the olfactory tract, which is damaged primarily by retractor pressure and strain. Thus, olfactory dysfunction following a pterional approach occurs most frequently in cases of ACoA aneuaBBreViatiONS ACoA = anterior communicating artery; AUC = area under the ROC curve; CTA = CT angiography; DSA = digital subtraction angiography; ROC = receiver operating characteristic; SAH = subarachnoid hemorrhage. OBJectiVe The highest incidence of olfactory dysfunction following a pterional approach and its modifications for an intracranial aneurysm has been reported in cases of anterior communicating artery (ACoA) aneurysms. The radiological characteristics of unruptured ACoA aneurysms affecting the extent of retraction of the frontal lobe and olfactory nerve were investigated as risk factors for postoperative olfactory dysfunction. methOdS A total of 102 patients who underwent a pterional or superciliary keyhole approach to clip an unruptured ACoA aneurysm from 2006 to 2013 were included in this study. Those patients who complained of permanent olfactory dysfunction after their aneurysm surgery, during a postoperative office visit or a telephone interview, were invited to undergo an olfactory test, the Korean version of the Sniffin' Sticks test. In addition, the angiographic characteristics of ACoA aneurysms, including the maximum diameter, the projecting direction of the aneurysm, and the height of the neck of the aneurysm, were all recorded based on digital subtraction angiography and sagittal brain images reconstructed using CT angiography. Furthermore, the extent of the brain retraction was estimated based on the height of the ACoA aneurysm neck. reSultS Eleven patients (10.8%) exhibited objective olfactory dysfunction in the Sniffin' Sticks test, among whom 9 were anosmic and 2 were hyposmic. Univariate and multivariate analyses revealed that the direction of the ACoA aneurysm, ACoA aneurysm neck height, and estimated extent of brain retraction were statistically significant risk factors for postoperative olfactory dysfunction. Based on a receiver operating characteristic (ROC) analysis, an ACoA aneurysm neck height > 9 mm and estimated brain retraction > 12 mm were chosen as the optimal cutoff values for differentiating anosmic/hyposmic from normosmic patients. The values for the area under the ROC curves were 0.939 and 0.961, respectively. cONcluSiONS In cases of unruptured ACoA aneurysm surgery, the height of the aneurysm neck and the estimated extent of brain retraction were both found to be powerful predictors of the occurrence of postoperative olfactory dysfunction.

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“…It had been thought that only serious injuries of the head with fractures of the anterior cranial fossa resulting in anatomical disruption of the olfactory filaments or tract cause permanent anosmia, but permanent anosmia can result from even trivial injuries [11]. Previous studies have reported anosmia after surgical treatment of anterior communicating artery (ACoA) aneurysms and suggest that its prevalence depends on the mode of approach to the aneurysm [6]. It has been mentioned that there are three mechanisms of olfactory nerve damage during frontal lobe retraction (depression and elevation): partial or total avulsion of the olfactory nerve from the cribriform plate [1–4, 6, 9]; injury during nerve dissection; and direct pressure damage [2, 9].…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies have reported anosmia after surgical treatment of anterior communicating artery (ACoA) aneurysms and suggest that its prevalence depends on the mode of approach to the aneurysm [6]. It has been mentioned that there are three mechanisms of olfactory nerve damage during frontal lobe retraction (depression and elevation): partial or total avulsion of the olfactory nerve from the cribriform plate [1–4, 6, 9]; injury during nerve dissection; and direct pressure damage [2, 9]. Cardali et al [2] suggested that maintaining the anatomic integrity of the nerve is important to preserve olfactory function.…”

Section: Discussionmentioning

confidence: 99%

“…The olfactory nerve and tracts are also at risk during intradural explorations using the interhemispheric approach or the frontotemporal approach [10, 11]. Both approaches require some degree of frontal lobe retraction, which may result in temporary or permanent olfactory dysfunction because of nerve avulsion or mechanical compression [3, 4, 6, 12]. A bilateral olfactory nerve deficit is unusual after a unilateral approach [9].…”

Section: Introductionmentioning

confidence: 99%

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Strength testing of the human olfactory nerve at the frontal skull base

Tomii

2012

Neurosurg Rev

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Olfactory dysfunction may influence the quality of life tremendously. This study investigated the strength of the human olfactory nerve at the frontal skull base using cadavers. A total of 180 olfactory nerves were examined in 90 human cadaveric heads. The cut edges of the olfactory nerves were pulled until they were pulled out from the skull base. In the first set of 30 cases, each right olfactory nerve was pulled 0° laterally and 0° upward, and each left olfactory nerve was pulled 0° laterally and 15° upward. In the second set of 30 cases, each right olfactory nerve was pulled 0° laterally and 15° upward, and each left olfactory nerve was pulled 15° laterally and 15° upward. In the third set of 30 cases, each right olfactory nerve was pulled 15° laterally and 15° upward, and each left olfactory nerve was pulled 30° laterally and 15° upward. The strength of the olfactory nerve was measured when pulled in each direction. There was no significant difference in the strength of the olfactory nerves when pulling them in the postero-upward direction between 0° and 15° upward. The strengths of the olfactory nerves when pulling them in the postero-lateral direction 0° and 15° laterally were 3.14±1.87 and 4.05±1.70 g (mean ± standard deviation [SD]), respectively; the difference was almost significant. The olfactory nerve could be pulled more laterally than posteriorly because the retraction force is absorbed by the lateral wall of the olfactory fossa.

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Olfactory dysfunction after subarachnoid hemorrhage caused by ruptured aneurysms of the anterior communicating artery

Abstract: Olfactory disorders after SAH caused by rupture of the ACoA are very frequent and were present in both treatment groups. Cerebral vasospasm and frontal lobe lesions are related to worse performance on an olfactory test in patients undergoing endovascular coil embolization.

Cited by 21 publications

References 24 publications

Vanadium exposure induces olfactory dysfunction in an animal model of metal neurotoxicity

Vanadium exposure induces olfactory dysfunction in an animal model of metal neurotoxicity

Height of aneurysm neck and estimated extent of brain retraction: powerful predictors of olfactory dysfunction after surgery for unruptured anterior communicating artery aneurysms

Strength testing of the human olfactory nerve at the frontal skull base

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