Lateral Supraorbital Approach Applied to Olfactory Groove Meningiomas

Romani, Rossana; Lehečka, Martin; Gaál, Emília Ilona; Toninelli, Stefano; Çelik, Özgür; Niemelä, Mika; Porras, Matti; Jääskeläinen, Juha E.; Hernesniemi, Juha

doi:10.1227/01.neu.0000346266.69493.88

Cited by 102 publications

(133 citation statements)

References 64 publications

(68 reference statements)

Supporting

Mentioning

118

Contrasting

Unclassified

Order By: Relevance

“…Several authors have reported complete resection rates of ≥ 90%, but only by including both Simpson Grade I and II, or without association of the degree of resection with the Simpson grading system. 31,35,39,42 As expected, authors who define GTR as Simpson Grade I only have reported lower GTR rates, ranging from 23.8% to 84.6%. 1,4,22 We use the same strict definition of GTR as Simpson Grade I only, and we also confirm the lack of residual meningioma in every case with postoperative MRI, which is critical for objective evaluation of resection.…”

Section: Surgical Outcomesupporting

confidence: 64%

“…6,21,22,31,41 However, there are reports that tumor size is not correlated with residual lesion. 35 With the endoscopic experience, Simpson Grade I resection can be achieved in 90.5% of olfactory groove meningiomas ≤ 40 mm, but only in 45.8% of tumors > 40 mm.…”

Section: Surgical Outcomementioning

confidence: 99%

“…31 The supraorbital approach represents a less invasive lateral approach to the anterior skull base with clinical outcomes similar to those with the pterional approach, but with less brain retraction and lower CSF leak rates in many cases. 35 With any of these approaches, posterior tumor extension, especially below the level of the tuberculum sellae, is difficult to visualize and resection may be blind in this area.…”

Section: Anterior (Subfrontal and Supraorbital) Approachmentioning

confidence: 99%

“…The surgical success in terms of improved symptomatology is well demonstrated in the literature, with rates of improvement in mental status or Karnofsky Performance Scale scores ranging from 11% to 88% and visual improvement in 55%-83% of cases. 4,31,35 However, some studies have even shown overall worsening of the Karnofsky Performance Scale score postoperatively.…”

Section: Surgical Outcomementioning

confidence: 99%

“…21,31,36,39,40,42 Major potential surgical complications include postoperative seizures, intracranial hemorrhage, subdural hygroma, worsening vision, motor deficits, CSF leakage, and meningitis. 1,4,11,21,22,31,35,39 The lack of brain manipulation by retraction is reflected by a comparison of postoperative complications. Postoperative generalized seizures occur following craniotomy for olfactory meningioma in 3.8%-11.8% of cases.…”

Section: Surgical Complicationsmentioning

confidence: 99%

See 4 more Smart Citations

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

Koutourousiou

Fernández-Miranda

Wang

et al. 2014

FOC

107

View full text Add to dashboard Cite

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.

show abstract

Section: Surgical Outcomesupporting

confidence: 64%

Section: Surgical Outcomementioning

confidence: 99%

Section: Anterior (Subfrontal and Supraorbital) Approachmentioning

confidence: 99%

Section: Surgical Outcomementioning

confidence: 99%

Section: Surgical Complicationsmentioning

confidence: 99%

See 3 more Smart Citations

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

Koutourousiou

Fernández-Miranda

Wang

et al. 2014

FOC

107

View full text Add to dashboard Cite

show abstract

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

et al. 2019

View full text Add to dashboard Cite

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.

show abstract