Preservation of olfaction in surgery of olfactory groove meningiomas

Jang, Won Young; Jung, Shin; Jung, Tae‐Young; Moon, Kyung‐Sub; Kim, In-Young

doi:10.1016/j.clineuro.2012.12.004

Cited by 47 publications

(51 citation statements)

References 20 publications

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“…The issue of olfaction preservation is often overlooked in the literature, and anosmia often regarded as minor morbidity, despite its significant impact on the QOL of patients . None of the reviewed studies formally reported olfaction outcomes, with the exception of Banu et al .…”

Section: Intradural Tumorsmentioning

confidence: 99%

“…This may be an important factor in deciding the best approach for OGM in patients with preserved olfaction. Jang et al . investigated factors associated with olfaction preservation following transcranial approaches to OGM in a series of 40 patients.…”

Section: Intradural Tumorsmentioning

confidence: 99%

“…More recent reports show increased rates of GTR but still less than those reported for transcranial approaches. Limitations of GTR include: (1) extension beyond mid‐orbit in the coronal plane; (2) extension to the posterior table of the frontal sinus in the sagittal plane; (3) absence of a cortical cuff with neurovascular encasement; (4) extensive calcification; and (5) tumor size >4 cm …”

Section: Intradural Tumorsmentioning

confidence: 99%

See 2 more Smart Citations

ICAR: endoscopic skull‐base surgery

Wang

Zanation

Gardner

et al. 2019

Int Forum Allergy Rhinol

157

279

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Background Endoscopic skull‐base surgery (ESBS) is employed in the management of diverse skull‐base pathologies. Paralleling the increased utilization of ESBS, the literature in this field has expanded rapidly. However, the rarity of these diseases, the inherent challenges of surgical studies, and the continued learning curve in ESBS have resulted in significant variability in the quality of the literature. To consolidate and critically appraise the available literature, experts in skull‐base surgery have produced the International Consensus Statement on Endoscopic Skull‐Base Surgery (ICAR:ESBS). Methods Using previously described methodology, topics spanning the breadth of ESBS were identified and assigned a literature review, evidence‐based review or evidence‐based review with recommendations format. Subsequently, each topic was written and then reviewed by skull‐base surgeons in both neurosurgery and otolaryngology. Following this iterative review process, the ICAR:ESBS document was synthesized and reviewed by all authors for consensus. Results The ICAR:ESBS document addresses the role of ESBS in primary cerebrospinal fluid (CSF) rhinorrhea, intradural tumors, benign skull‐base and orbital pathology, sinonasal malignancies, and clival lesions. Additionally, specific challenges in ESBS including endoscopic reconstruction and complication management were evaluated. Conclusion A critical review of the literature in ESBS demonstrates at least the equivalency of ESBS with alternative approaches in pathologies such as CSF rhinorrhea and pituitary adenoma as well as improved reconstructive techniques in reducing CSF leaks. Evidence‐based recommendations are limited in other pathologies and these significant knowledge gaps call upon the skull‐base community to embrace these opportunities and collaboratively address these shortcomings.

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Section: Intradural Tumorsmentioning

confidence: 99%

Section: Intradural Tumorsmentioning

confidence: 99%

Section: Intradural Tumorsmentioning

confidence: 99%

See 1 more Smart Citation

ICAR: endoscopic skull‐base surgery

Wang

Zanation

Gardner

et al. 2019

Int Forum Allergy Rhinol

157

279

View full text Add to dashboard Cite

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“…There are several reports of using a unilateral craniotomy approach to preserve olfaction in the setting of olfactory groove meningiomas; however, by the nature of tumor involvement, this necessitates a higher Simpson grade resection and therefore greater risk of recurrence. 23 This could be considered for patients in whom olfaction is paramount, but with the inconsistency of preservation and tradeoff for completeness of resection considered.…”

mentioning

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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“…Later, lateralized testing of olfaction appears to be more sensitive than bilateral testing. Since self‐perception of anosmia usually constitutes bilaterally impaired olfactory transmission, self‐perceived anosmia is associated with larger tumor size (Bakay, ; Welge‐Luessen, ; Gudziol et al, ; Jang et al, ; Poupon et al, ). Surgical resection aims for gross total resection while ideally sparing olfactory function and preventing surgical complications like CSF leakage.…”

Section: Discussionmentioning

confidence: 99%

Perioperative olfactory dysfunction in patients with meningiomas of the anteromedial skull base

et al. 2019

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Olfactory dysfunction represents a main symptom in olfactory groove meningiomas (OGM). Besides this, olfactory function has been sparsely investigated in patients suffering from supratentorial meningiomas. Here, the authors explore pre‐ and postoperative variables associated with olfactory dysfunction in supratentorial meningioma patients. This is a retrospective study on supratentorial meningioma patients who underwent meningioma resection between January 2015 and January 2016. Preoperative and postoperative olfactory performance was quantified using a lateralized sniffin' stick odor identification test. Meningiomas affecting the olfactory system (n = 23) were compared to meningiomas in other locations among the control group (n = 40). Meningiomas that affected the olfactory system had odds of 3.6 and 3.7 in being associated with ipsilateral (lesional) and bilateral anosmia, respectively. Subgroup analysis revealed that meningiomas causing a midline shift across the frontal base and older age represented risk factors for preoperative anosmia. The odds of experiencing acquired postoperative ipsilateral anosmia were significantly increased in olfactory system affecting meningiomas (OR 11.1). Subgroup analysis highlighted OGMs to represent the predominant location associated with deterioration. General surgical complications predisposed patients to loss of contralateral (OR 12.3) and bilateral olfactory function (OR 27.8). Older age and meningiomas causing a midline shift across the frontal base predispose patients to preoperative olfactory dysfunction. Resection of OGMs and surgical complications are risk factors for postoperative olfactory deterioration to anosmia. Likely, olfactory dysfunction is underrecognized even in OGMs. In OGM surgery, however, preoperative lateralized testing might be critical to selecting an appropriate surgical route to preserve olfactory function. Clin. Anat. 32:524–533, 2019. © 2019 Wiley Periodicals, Inc.

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Preservation of olfaction in surgery of olfactory groove meningiomas

Cited by 47 publications

References 20 publications

ICAR: endoscopic skull‐base surgery

ICAR: endoscopic skull‐base surgery

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

Perioperative olfactory dysfunction in patients with meningiomas of the anteromedial skull base

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