Olfactory Groove Meningiomas

Nakamura, Makoto; Struck, Melena; Röser, Florian; Vorkapic, Peter; Samii, M.

doi:10.1227/01.neu.0000255453.20602.80

Cited by 166 publications

(215 citation statements)

References 30 publications

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“…The leading reason for improved surgical results is the use of the operating microscope in contemporary skull base approaches. 4,9,15,31,40 The goal of cranial base approaches is removal of superficial bone to increase surgical access and totally resect basal tumors such as olfactory groove meningiomas with minimal brain retraction, avoidance of vascular injury, and minimization of the risk of optic nerve damage when the tumor extends posteriorly, all with acceptable cosmetic results.…”

Section: Discussionmentioning

confidence: 99%

Endoscopic endonasal surgery for olfactory groove meningiomas: outcomes and limitations in 50 patients

Koutourousiou

Fernández-Miranda

Wang

et al. 2014

FOC

111

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Object Recently, endoscopic endonasal surgery (EES) has been introduced in the management of skull base tumors, with constantly improving outcomes and increasing indications. The authors retrospectively reviewed the effectiveness of EES in the management of olfactory groove meningiomas. Methods Between February 2003 and December 2012, 50 patients (64% female) with olfactory groove meningiomas underwent EES at the University of Pittsburgh Medical Center. The authors present the results of EES and analyze the resection rates, clinical outcome, complications, and limitations of this approach. Results Forty-four patients presented with primary tumors, whereas six were previously treated elsewhere. The patients’ mean age was 57.1 years (range 27–88 years). Clinical presentation included altered mental status (36%), visual loss (30%), headache (24%), and seizures (20%). The mean maximum tumor diameter was 41.6 mm (range 18–80 mm). All patients underwent EES, which was performed in stages in 18 giant tumors. Complete tumor resection (Simpson Grade I) was achieved in 66.7% of the 45 patients in whom it was the goal, and 13 (28.9%) had near-total resection (> 95% of the tumor). Tumor size, calcification, and absence of cortical cuff from vasculature were significant factors that influenced the degree of resection (p = 0.002, p = 0.024, and p = 0.028, respectively). Tumor residual was usually at the most lateral and anterior tumor margins. Following EES, mental status was improved or normalized in 77.8% of the cases, vision was improved or restored in 86.7 %, and headaches resolved in 83.3 %. There was no postoperative deterioration of presenting symptoms. Complications were increased in tumors > 40 mm and included CSF leakage (30%), which was significantly associated with lobular tumor configuration (p = 0.048); pulmonary embolism/deep vein thrombosis, more commonly in elderly patients (20%); sinus infections (10%); and delayed abscess months or years after EES (6%). One patient had an intraoperative vascular injury resulting in transient hemiparesis (2%). There were no perioperative deaths. During a mean follow-up period of 32 months (median 22 months, range 1–115 months), 1 patient underwent repeat EES for tumor regrowth. Conclusions Endoscopic endonasal surgery has shown good clinical outcomes regardless of patient age, previous treatment, or tumor characteristics. Tumor size > 40 mm, calcification, and absence of cortical vascular cuff limit GTR with EES; in addition, large tumors are associated with increased postoperative complications. Significant lateral and anterior dural involvement may represent indications for using traditional craniotomies for the management of these tumors. Postoperative CSF leakage remains a problem that necessitates innovations in EES reconstruction techniques.

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Section: Discussionmentioning

confidence: 99%

Endoscopic endonasal surgery for olfactory groove meningiomas: outcomes and limitations in 50 patients

Koutourousiou

Fernández-Miranda

Wang

et al. 2014

FOC

111

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“…There are no studies evaluating the pre-and post-operative mental status of the patients quantitatively. Different ratios of improvement of mental functions are reported (4,16,18,23,28). With the unilateral approach, our patients showed significant improvement in their MMT scores.…”

Section: Resultsmentioning

confidence: 54%

“…Because of the slow growth pattern of these tumors, the initial clinical symptoms are usually related to the frontal lobe (4,16,27). With a unilateral approach, the left frontal lobe was protected from surgical injury and the right frontal lobe was preserved from several injuries related to over-retraction.…”

Section: Resultsmentioning

confidence: 99%

“…Zevgaridis et al reported similar results using bifrontal and frontal approaches (30). Nakamura et al reported that 55% of their patients showed visual improvement; however, they used a frontolateral and bifrontal approach (16). Bassiouni reported an 83% improvement in visual acuity and 100% improvement in visual field using primarily a bifrontal and pterional approach (4).…”

Section: Musluman Am Et Al: Olfactory Groove Meningiomasmentioning

confidence: 99%

“…Nakamura et al (16) reported that via a frontolateral approach, they made a 2 x 2.5-cm craniotomy incision between the lateral rim of frontal sinus and orbital button, opened the Sylvian fissure to drain CSF and thus relieved the cerebral pressure with minimal frontal lobe retraction. They extracted through such a narrow opening larger tumors, up to 8 cm in the longest dimension, without any serious complication.…”

Section: Musluman Am Et Al: Olfactory Groove Meningiomasmentioning

confidence: 99%

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unilateral frontal interhemispheric transfalcial approaches for the removal of olfactory groove meningiomas

Müslüman¹,

Yılmaz²,

R³

et al. 2011

Turkish Neurosurgery

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AIm: A unilateral subfrontal interhemispheric transfalcial approach for the removal of olfactory groove meningiomas (OGM) was evaluated in terms of surgical technique, complications, clinical outcomes, and recurrence rate. mAterIAl and methOds: Twenty-four females and eighteen males with a mean age of 59 years were operated on for OGM within a 12-year (1996-2008) period. The pre-and post-operative Mini-Mental Test (MMT) scores, visual impairment scores (VIS), pre-operative clinical symptoms (headache, epileptic seizure and anosmia), Karnofsky performance scores (KPS), tumor size and tumor extensions were evaluated. The effects of the pre-operative parameters on post-operative MMT, VIS and KPS were investigated. results:Tumor size and pre-operative MMT significantly affected pre-operative KPS. Mean tumor diameter was 5.6±0.8 cm. Total excision was achieved in 97.6% of all cases. No peri-operative mortality was seen. Ten patients (23.8%) experienced surgery-related complications. The mean follow-up period of cases was 52 months, and the rate of residual tumor re-growth was 2.3%. No parameter showed any effect on post-operative KPS, as no significant difference was seen between pre-and post-operative KPS. A significant positive difference was detected between pre-and post-operative MMT and VIS.COnClusIOn: A unilateral subfrontal interhemispheric transfalcial approach can be the preferred modality for treating OGM. BulGulAr: Tümör boyutu ve ameliyat öncesi MMT ameliyat öncesi KPS nu anlamlı etkiledi. Ortalama tümör çapı 5.6 ± 0.8 cm idi. Total eksizyon olguların % 97.6 sında sağlandı. Peri-operatif mortalite görülmedi. On hastada (% 23.8) cerrahiye bağlı istenmeyen durum meydana geldi. Olguların ortalama takip süresi 52 aydı, nüks oranı% 2.3 idi. Ameliyat öncesi ve sonrası KPS arasında anlamlı bir fark görülmedi. Hiçbir parametre, post-operatif KPS üzerine anlamlı bir etki göstermedi. Anlamlı pozitif fark ameliyat öncesi ve sonrası MMT ve VIS arasında tespit edildi.sOnuÇ: Tek taraflı subfrontal interhemisferik transfalcian yaklaşım OOM tedavisi için tercih edilebilecek yöntem olabilir.

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Update on endoscopic endonasal resection of skull base meningiomas

Brunworth

Padhye

Bassiouni

et al. 2014

Int Forum Allergy Rhinol

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Using a 2-team approach, meningiomas of the skull base were successfully removed via an intranasal endoscopic technique. Although complete resection is typically possible even with large tumors, the lengthy resection required time for tumors larger than 60 cm(3) (diameter ≥4 cm) may obviate some of the advantages of this approach. The rate of postoperative CSF leak decreases when a synthetic dural substitute is added but does not approach zero.

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Olfactory Groove Meningiomas

Cited by 166 publications

References 30 publications

Endoscopic endonasal surgery for olfactory groove meningiomas: outcomes and limitations in 50 patients

Endoscopic endonasal surgery for olfactory groove meningiomas: outcomes and limitations in 50 patients

unilateral frontal interhemispheric transfalcial approaches for the removal of olfactory groove meningiomas

Update on endoscopic endonasal resection of skull base meningiomas

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