Interhemispheric approach for microsurgical removal of olfactory groove meningiomas

Abstract

Eighteen consecutive patients with olfactory groove meningiomas, with diameters ranging from 1.5 to 7 cm, underwent microsurgical tumour resection using a unilateral frontal interhemispheric approach. Unilateral frontal craniotomy, superior to the frontal sinus, exposing the superior sagittal sinus was performed. The ipsilateral frontal lobe was gently retracted laterally, and the tumour resected through the gap between the falx and the medial aspect of the frontal lobe, anteriorly to the genu of the corpus callosum. Gross total tumour resection was achieved in all the patients. There was no evidence of damage to the frontal lobes, the anterior cerebral arteries or the optic system. Compared with the more commonly applied subfrontal route, the interhemispheric approach has the advantages of sparing the frontal sinuses and providing excellent overview of the dissection of the anterior cerebral arteries and the optic system, as well as for the resection of tumour invading the frontal cranial base.

Giant Olfactory Meningiomas: The Pterional Approach and Its Relevance for Minimizing Surgical Morbidity

“…The pterional approach for the removal of olfactory groove meningiomas has been comprehensively described by Hassler Yasargil.15 Advantages and disadvantages of this surgical strategy have been discussed recently. [22][23][24] In this paper, we report our experience with the pterional approach in a selected group of patients with giant olfactory meningiomas. Although limited in numbers, this series is unique because it includes only patients harboring olfactory meningiomas exceeding 6 cm in diameter.…”

“…22 Recently, an interhemispheric approach has been proposed as a recommendable alternative to the subfrontal route. 24 According to Yasargil,15 the pterional-transsylvian approach takes advantage of those planes and spaces naturally provided to expose the base of the brain without significant brain retraction. Moreover, large tumors produce large "birth" canals15 through which atraumatic decompression of the frontal lobes can be performed.…”

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

“…Identification and cauterization of these nutrient arteries were provided by starting from the anterior part of the tumor's basal portion in our unilateral approach. Earlier blockage of tumoral blood supply permits non-traumatic dissection of the frontal lobe and thus excellent visualization of ACAs, optic nerves and chiasm (14). With this approach, we obtained significantly better post-operative VIS than pre-operative VIS.…”

“…Some surgeons reported that they prefer to define the surgical approaches as pterional and subfrontal based on the localization of the tumor (27). Some other surgeons prefer to use either a pterional (10,20,27), unilateral or bilateral subfrontal approach regardless of the localization of the tumor (3,5,7,11,14,18,19,25). Al Mefty (2) and Babu et al (3) combined orbital osteotomy with the unilateral frontal approach.…”

“…Nutrient arteries of olfactory groove meningiomas usually arise from anterior and posterior ethmoidal, middle meningeal and ophthalmic arteries (4,11,14). Identification and cauterization of these nutrient arteries were provided by starting from the anterior part of the tumor's basal portion in our unilateral approach.…”