Olfactory groove meningiomas: Approaches and complications

Aguiar, Paulo Henrique Pires de; Tahara, Adriana; Almeida, Antônio Nogueira de; Simm, Renata; Silva, Arnaldo Neves da; Maldaun, Marcos Vinicius Calfatt; Panagopoulos, Alexandros; Zicarelli, Carlos Alexandre Martins; Silva, Pedro Gabriel

doi:10.1016/j.jocn.2008.12.013

Cited by 58 publications

(64 citation statements)

References 28 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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. With these criteria, the GTR rate of EES is 66.7% when GTR is the goal of surgery, in line with the largest published series of Simpson Grade I resection performed via traditional open approaches.…”

Section: Surgical Outcomesupporting

confidence: 60%

“…1,4,11,31,35,38,39 Endoscopic endonasal surgery remains a safe approach for olfactory groove meningiomas, with 0% perioperative mortality in this series.…”

Section: Surgical Complicationsmentioning

confidence: 74%

“…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%

“…20,21,31,42 Still, CSF leakage after transcranial surgery can be quite high, and rates reaching 19% have been reported in the literature. 1,11,31,32,35,39 As an approach to the tumor through the ethmoidal sinuses, EES is associated with higher rates of CSF leakage, a fact that has motivated endoscopic skull base surgeons to develop new reconstruction techniques. And, although the innovation of the vascularized nasoseptal reconstruction technique has dramatically decreased the CSF leak rates in other pathological entities, the extensive skull base defect after olfactory groove meningioma surgery remains a reconstruction challenge.…”

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

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: 60%

“…1,4,11,31,35,38,39 Endoscopic endonasal surgery remains a safe approach for olfactory groove meningiomas, with 0% perioperative mortality in this series.…”

Section: Surgical Complicationsmentioning

confidence: 74%

Section: Surgical Complicationsmentioning

confidence: 99%

Section: Surgical Complicationsmentioning

confidence: 99%

See 2 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

“…raise controversies related to the best surgical approaches to deal with these lesions 1,5,8,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25 . In our study, we describe a unique operative strategy and personal nuances of the microsurgical technique.…”

Section: A B C D E Fmentioning

confidence: 99%

The extended pterional approach allows excellent results for removal of anterior cranial fossa meningiomas

Lynch

Gonçalves

Pereira

et al. 2016

Arq. Neuro-Psiquiatr.

View full text Add to dashboard Cite

Objective To describe a unique operative strategy, instead the classical pterional approach, and to analyses it safety and effectiveness for removal of anterior cranial fossa meningiomas. Method We identify 38 patients with tuberculum sellae and olphactory groove meningiomas operated between 1986 and 2013. Medical charts, operative reports, imaging studies and clinical follow-up evaluations were reviewed and analyzed retrospectively. The pterional craniotomy is extended toward the frontal bone providing access through the subfrontal route, besides the usual anterolateral view provided by the classical pterional approach. Results Surgical mortality occurred in one patient (2.6%). Gross total resection was achieved in 27 patients (86.8%). Median time of follow-up was 69.4 months. Conclusion The extended pterional approach allows excellent results. Total removal of meningiomas of the anterior cranial fossa was obtained in 86.8 % of patients, with low morbidity and mortality.

show abstract