Abstract:Meningiomas, usually histologically benign tumors, are originating from the arachnoidal cap cells normally present intracranially in varying sites. Olfactory groove meningeomas arise from the medline of the anterior fossa between the crista galli and the tuberculum sellae. The most common presenting symptoms are the visual field defects, epilepsy, and psychological change. They are often large before they are detected because of slowly asymptomatic growing in the interhemispheric space of the frontal lobes. Th… Show more
“…For TSM, 44 case series (of which 11 were in eTSA, 29 in mTCA, and 4 in both) were included in the meta-analysis for the different outcomes, including a total of 1444 patients [ 3 , 5 , 8 , 11 – 13 , 15 , 16 , 20 , 21 , 23 , 25 , 29 , 30 , 32 , 34 – 36 , 40 , 41 , 43 , 45 , 47 – 53 , 56 , 58 , 61 – 63 , 65 , 66 , 68 , 69 , 72 , 73 , 77 , 79 , 81 , 82 ]. As for OGM, 25 case series (of which 6 were in eTSA, 18 in mTCA, and 1 in both) were included describing outcomes in 891 patients [ 2 , 4 , 6 , 7 , 17 , 19 , 22 , 24 , 25 , 35 , 37 , 40 , 44 , 47 , 55 , 57 , 60 , 62 , 64 , 67 , 68 , 70 , 75 , 76 , 78 ]. …”
Section: Resultsmentioning
confidence: 99%
“…Visual improvement in OGM patients was described four eTSA studies [ 4 , 40 , 44 , 62 ] and nine mTCA studies [ 6 , 7 , 47 , 57 , 60 , 68 , 70 , 75 , 78 ] with 224 patients presenting with visual symptoms. The resulting fixed overall improvement rate was 64.5% (95% CI: 37.9–84.4%, p-heterogeneity = 0.03; I 2 = 65.5%) for eTSA compared to 50.6% (95% CI = 42.9–58.4%, p-heterogeneity <0.01, I 2 = 68.6%) for mTCA; however, this difference was not significant (p-interaction value: 0.33).…”
Section: Visual Improvementmentioning
confidence: 99%
“…For OGM, 7 eTSA studies [ 4 , 22 , 24 , 35 , 40 , 44 , 62 ] and 19 mTCA studies [ 2 , 6 , 7 , 17 , 19 , 22 , 25 , 37 , 47 , 55 , 57 , 60 , 64 , 67 , 68 , 70 , 75 , 76 , 78 ] including described mortality incidence. For eTSA, the overall 30-day mortality incidence was 4.27% (95% CI = 1.50–11.6%, p-heterogeneity = 0.94; I 2 = 0%; 82 patients), which was not significantly different from the mortality incidence in the mTCA group (incidence = 3.92%, 95% CI = 2.66–5.75, p-heterogeneity = 0.74, I 2 = 0%; 779 patients) in fixed models (p-interaction = 0.88).…”
ObjectIn the past decade, the endonasal transsphenoidal approach (eTSA) has become an alternative to the microsurgical transcranial approach (mTCA) for tuberculum sellae meningiomas (TSMs) and olfactory groove meningiomas (OGMs). The aim of this meta-analysis was to evaluate which approach offered the best surgical outcomes.MethodsA systematic review of the literature from 2004 and meta-analysis were conducted in accordance with the PRISMA guidelines. Pooled incidence was calculated for gross total resection (GTR), visual improvement, cerebrospinal fluid (CSF) leak, intraoperative arterial injury, and mortality, comparing eTSA and mTCA, with p-interaction values.ResultsOf 1684 studies, 64 case series were included in the meta-analysis. Using the fixed-effects model, the GTR rate was significantly higher among mTCA patients for OGM (eTSA: 70.9% vs. mTCA: 88.5%, p-interaction < 0.01), but not significantly higher for TSM (eTSA: 83.0% vs. mTCA: 85.8%, p-interaction = 0.34). Despite considerable heterogeneity, visual improvement was higher for eTSA than mTCA for TSM (p-interaction < 0.01), but not for OGM (p-interaction = 0.33). CSF leak was significantly higher among eTSA patients for both OGM (eTSA: 25.1% vs. mTCA: 10.5%, p-interaction < 0.01) and TSM (eTSA: 19.3%, vs. mTCA: 5.81%, p-interaction < 0.01). Intraoperative arterial injury was higher among eTSA (4.89%) than mTCA patients (1.86%) for TSM (p-interaction = 0.03), but not for OGM resection (p-interaction = 0.10). Mortality was not significantly different between eTSA and mTCA patients for both TSM (p-interaction = 0.14) and OGM resection (p-interaction = 0.88). Random-effect models yielded similar results.ConclusionIn this meta-analysis, eTSA was not shown to be superior to mTCA for resection of both OGMs and TSMs.Electronic supplementary materialThe online version of this article (10.1007/s00701-017-3390-y) contains supplementary material, which is available to authorized users.
“…For TSM, 44 case series (of which 11 were in eTSA, 29 in mTCA, and 4 in both) were included in the meta-analysis for the different outcomes, including a total of 1444 patients [ 3 , 5 , 8 , 11 – 13 , 15 , 16 , 20 , 21 , 23 , 25 , 29 , 30 , 32 , 34 – 36 , 40 , 41 , 43 , 45 , 47 – 53 , 56 , 58 , 61 – 63 , 65 , 66 , 68 , 69 , 72 , 73 , 77 , 79 , 81 , 82 ]. As for OGM, 25 case series (of which 6 were in eTSA, 18 in mTCA, and 1 in both) were included describing outcomes in 891 patients [ 2 , 4 , 6 , 7 , 17 , 19 , 22 , 24 , 25 , 35 , 37 , 40 , 44 , 47 , 55 , 57 , 60 , 62 , 64 , 67 , 68 , 70 , 75 , 76 , 78 ]. …”
Section: Resultsmentioning
confidence: 99%
“…Visual improvement in OGM patients was described four eTSA studies [ 4 , 40 , 44 , 62 ] and nine mTCA studies [ 6 , 7 , 47 , 57 , 60 , 68 , 70 , 75 , 78 ] with 224 patients presenting with visual symptoms. The resulting fixed overall improvement rate was 64.5% (95% CI: 37.9–84.4%, p-heterogeneity = 0.03; I 2 = 65.5%) for eTSA compared to 50.6% (95% CI = 42.9–58.4%, p-heterogeneity <0.01, I 2 = 68.6%) for mTCA; however, this difference was not significant (p-interaction value: 0.33).…”
Section: Visual Improvementmentioning
confidence: 99%
“…For OGM, 7 eTSA studies [ 4 , 22 , 24 , 35 , 40 , 44 , 62 ] and 19 mTCA studies [ 2 , 6 , 7 , 17 , 19 , 22 , 25 , 37 , 47 , 55 , 57 , 60 , 64 , 67 , 68 , 70 , 75 , 76 , 78 ] including described mortality incidence. For eTSA, the overall 30-day mortality incidence was 4.27% (95% CI = 1.50–11.6%, p-heterogeneity = 0.94; I 2 = 0%; 82 patients), which was not significantly different from the mortality incidence in the mTCA group (incidence = 3.92%, 95% CI = 2.66–5.75, p-heterogeneity = 0.74, I 2 = 0%; 779 patients) in fixed models (p-interaction = 0.88).…”
ObjectIn the past decade, the endonasal transsphenoidal approach (eTSA) has become an alternative to the microsurgical transcranial approach (mTCA) for tuberculum sellae meningiomas (TSMs) and olfactory groove meningiomas (OGMs). The aim of this meta-analysis was to evaluate which approach offered the best surgical outcomes.MethodsA systematic review of the literature from 2004 and meta-analysis were conducted in accordance with the PRISMA guidelines. Pooled incidence was calculated for gross total resection (GTR), visual improvement, cerebrospinal fluid (CSF) leak, intraoperative arterial injury, and mortality, comparing eTSA and mTCA, with p-interaction values.ResultsOf 1684 studies, 64 case series were included in the meta-analysis. Using the fixed-effects model, the GTR rate was significantly higher among mTCA patients for OGM (eTSA: 70.9% vs. mTCA: 88.5%, p-interaction < 0.01), but not significantly higher for TSM (eTSA: 83.0% vs. mTCA: 85.8%, p-interaction = 0.34). Despite considerable heterogeneity, visual improvement was higher for eTSA than mTCA for TSM (p-interaction < 0.01), but not for OGM (p-interaction = 0.33). CSF leak was significantly higher among eTSA patients for both OGM (eTSA: 25.1% vs. mTCA: 10.5%, p-interaction < 0.01) and TSM (eTSA: 19.3%, vs. mTCA: 5.81%, p-interaction < 0.01). Intraoperative arterial injury was higher among eTSA (4.89%) than mTCA patients (1.86%) for TSM (p-interaction = 0.03), but not for OGM resection (p-interaction = 0.10). Mortality was not significantly different between eTSA and mTCA patients for both TSM (p-interaction = 0.14) and OGM resection (p-interaction = 0.88). Random-effect models yielded similar results.ConclusionIn this meta-analysis, eTSA was not shown to be superior to mTCA for resection of both OGMs and TSMs.Electronic supplementary materialThe online version of this article (10.1007/s00701-017-3390-y) contains supplementary material, which is available to authorized users.
“…Postoperative complications were observed in up to 25% of patients with OGM in previous series (infection, hematoma, epidural empiema, CSF leakage and new neurological deficits) [1,6,7,13,18,32,38,41], and [49].…”
We report here a retrospective study of 59 consecutive patients with olfactory groove meningiomas admitted and operated on between 1991 and 2008. Our goal was to characterize clinical features, treatment strategies, and outcome of these lesions. The surgical resection grade, the histological type and the presence of recurrences in the follow-up period were analyzed. Maximum tumor diameter determined by preoperative magnetic resonance imaging (MRI) examinations was between 2 and 11 cm. In 38 surgical procedures (64.4%), the tumor was removed through a bilateral subfrontal approach, in 12 (20.3%) a unilateral subfrontal approach was used, and in nine procedures (15.3%) a pterional approach was performed. The average age at presentation was 52 years (age: 20-76 years) and the sex ratio was 1.45:1 (females/males). According to Simpson's grading system, the degree of tumor removal was: grade I in 14 cases (23.8%), grade II in 38 cases (64.4%), grade III in four cases (6.8%) and grade IV in three cases (5%). Fifty-six patients had benign meningiomas (94.9%) and three patients had atypical meningiomas (5.1%). Two patients (3.4%) died from pulmonary embolism and bronchopneumonia. There were recurrences in six patients (10.1%), between 9 months and 12 years (mean 7.2 years) after surgery. The olfactory groove is a relatively frequent location for intracranial meningiomas, accounting for 9.1% of all intracranial meningiomas in our experience. Olfactory groove meningiomas tend to be clinically silent tumors until they are very large when symptoms or other abnormalities become evident. A surgical procedure adapted to the size and the extension of the tumor combined with microsurgical techniques allows total meningioma removal with good neurological outcome.
Background Surgical resection of olfactory groove meningiomas (OGMs) is challenging and lots of surgical approaches can be chosen. We conducted a systematic review and meta-analysis of the studies investigating surgical resection of OGMs to better understand the surgical treatment of OGMs.Methods PubMed, Embase and Cochrane Library were used to search the studies reporting treatment outcomes of surgery for patients with OGMs. The final eligible studies were assessed using the Oxford Center for Evidence Based Medicine for level of evidence. Relevant parameters were extracted to perform descriptive and/or quantitative analyses.Results A total of 42 studies including 1673 patients were included in this systematic review (8 level 3 studies and 34 level 4 studies). Surgeries through transcranial approaches (TCAs) and endoscopic endonasal approach (EEA) were done on 1596 and 77 patients, respectively. Based on a random effects model, rates of gross total resection (GTR) and cerebrospinal fluid (CSF) leak were determined to be 92.4% (CI: 88.6-95.5%) and 5.9% (95% CI: 3.4-9%), respectively. The mortality following surgery was 1.6% (95% CI: 0.9-2.5%) under a fixed effects model. Through subgroup analyses, TCAs were found to be more favorable in GTR and CSF leakage compared to EEA. Besides, anterolateral TCA was associated with better control of CSF leakage than anterior TCA. Conclusion Surgical treatment is capable of achieving GTR in the vast majority of patients with OGMs and postoperative mortality is under well control. Transcranial approach allows a better chance of GTR and better control of CSF leak in comparison to EEA. In comparison to anterior TCA, anterolateral TCA is associated less mortality. However, low evidence level and significant heterogeneity of the included studies prevent the formation of more solid conclusions.
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