Superior Ethmoidal Approach to an Olfactory Groove Meningioma: Maximizing Preservation of Nasal Anatomy: 2-Dimensional Operative Video

Abstract

Olfactory groove meningiomas can be approached through a transcranial or expanded endoscopic endonasal approach. Benefits of the expanded endoscopic endonasal approach to olfactory groove meningiomas include early devascularization of the tumor, direct access to the dura from which the tumor arises, obviation of frontal lobe retraction, and, if bony extension of the tumor is present, immediate access to the involved bone. Disadvantages of the expanded endoscopic endonasal approach include loss of smell, which is a direct sequela of the approach as the olfactory apparatus is removed, and removal of the ostiomeatal nasal complex, which may predispose the patient to colder, nonphysiological nasal airflow and consequent nasal crusting. 1 To mitigate the removal of normal nasal anatomy, recent publications have suggested the superior ethmoidal approach, which preserves the attachments of the middle turbinate and structures of the middle meatus, thus preserving physiological nasal airflow. 2,3 While descriptions of this approach exist in the literature, no video details its operative steps while highlighting the anatomy involved in its successful execution. In this video, we present the case of a 67-year-old woman with an incidentally found olfactory groove meningioma. Despite having residual olfaction, she did not want a transcranial approach and elected to undergo resection through an endoscopic endonasal, superior ethmoidal approach. Gross total resection of the lesion was achieved. This manuscript was conducted in accordance with the ethical standards of our institution's Institutional Review Board. The patient gave informed consent for surgery and video recording.