The Pterional Approach for the Microsurgical Removal of Olfactory Groove Meningiomas

Turazzi, S.; Cristofori, L.; Gambin, Roberta; Bricolo, Albino

doi:10.1097/00006123-199910000-00016

Cited by 88 publications

(91 citation statements)

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“…6,15,34,42 It is indicated for smaller olfactory groove meningiomas, with the advantage of early exposure of the ipsilateral supraclinoid carotid artery, optic nerve, and ACA, with CSF draining from the opticocarotid cistern to decrease brain retraction. 6,20,31,42 The pterional approach is less time-consuming than the anterior approaches and usually avoids CSF leakage because the frontal sinus is not transgressed. 39 Early access to the basal cisterns allows for CSF drainage, providing fair brain relaxation.…”

Section: Anterior (Subfrontal and Supraorbital) Approachmentioning

confidence: 99%

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

Koutourousiou

Fernández-Miranda

Wang

et al. 2014

FOC

107

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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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Section: Anterior (Subfrontal and Supraorbital) Approachmentioning

confidence: 99%

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

Koutourousiou

Fernández-Miranda

Wang

et al. 2014

FOC

107

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“…There are no studies evaluating the pre-and post-operative mental status of the patients quantitatively. Different ratios of improvement of mental functions are reported (4,16,18,23,28). With the unilateral approach, our patients showed significant improvement in their MMT scores.…”

Section: Resultsmentioning

confidence: 53%

“…The pterional approach is the shortest way to reach the parasellar region (10,28). The posterior pole of the tumor can be dissected and separated from the optic nerve and cerebral arteries earlier in the procedure.…”

Section: Resultsmentioning

confidence: 99%

“…The posterior pole of the tumor can be dissected and separated from the optic nerve and cerebral arteries earlier in the procedure. Turazzi et al (28) demonstrated that this approach provides a shorter route to the tumor than a subfrontal approach. Venous compression due to retraction of the frontal lobes can be avoided.…”

Section: Resultsmentioning

confidence: 99%

“…Several surgical approaches to olfactory groove meningiomas have been described (Table IV). Conventional approaches are frontal or bifrontal craniotomy with a subfrontal approach (13,17,19,23,25,30), and a pterional approach is also used by many surgeons (10,20,28). In cases where orbita and paranasal sinuses are exposed to tumoral invasion, craniofascial approaches can be used, which include frontal or bifrontal craniotomy combined with orbital and nasal osteotomies (2,3,6,11,17,24).…”

Section: Discussionmentioning

confidence: 99%

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

Müslüman¹,

Yılmaz²,

R³

et al. 2011

Turkish Neurosurgery

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AIm: A unilateral subfrontal interhemispheric transfalcial approach for the removal of olfactory groove meningiomas (OGM) was evaluated in terms of surgical technique, complications, clinical outcomes, and recurrence rate. mAterIAl and methOds: Twenty-four females and eighteen males with a mean age of 59 years were operated on for OGM within a 12-year (1996-2008) period. The pre-and post-operative Mini-Mental Test (MMT) scores, visual impairment scores (VIS), pre-operative clinical symptoms (headache, epileptic seizure and anosmia), Karnofsky performance scores (KPS), tumor size and tumor extensions were evaluated. The effects of the pre-operative parameters on post-operative MMT, VIS and KPS were investigated. results:Tumor size and pre-operative MMT significantly affected pre-operative KPS. Mean tumor diameter was 5.6±0.8 cm. Total excision was achieved in 97.6% of all cases. No peri-operative mortality was seen. Ten patients (23.8%) experienced surgery-related complications. The mean follow-up period of cases was 52 months, and the rate of residual tumor re-growth was 2.3%. No parameter showed any effect on post-operative KPS, as no significant difference was seen between pre-and post-operative KPS. A significant positive difference was detected between pre-and post-operative MMT and VIS.COnClusIOn: A unilateral subfrontal interhemispheric transfalcial approach can be the preferred modality for treating OGM. BulGulAr: Tümör boyutu ve ameliyat öncesi MMT ameliyat öncesi KPS nu anlamlı etkiledi. Ortalama tümör çapı 5.6 ± 0.8 cm idi. Total eksizyon olguların % 97.6 sında sağlandı. Peri-operatif mortalite görülmedi. On hastada (% 23.8) cerrahiye bağlı istenmeyen durum meydana geldi. Olguların ortalama takip süresi 52 aydı, nüks oranı% 2.3 idi. Ameliyat öncesi ve sonrası KPS arasında anlamlı bir fark görülmedi. Hiçbir parametre, post-operatif KPS üzerine anlamlı bir etki göstermedi. Anlamlı pozitif fark ameliyat öncesi ve sonrası MMT ve VIS arasında tespit edildi.sOnuÇ: Tek taraflı subfrontal interhemisferik transfalcian yaklaşım OOM tedavisi için tercih edilebilecek yöntem olabilir.

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Skull base approaches in the pediatric population

et al. 2005

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The Pterional Approach for the Microsurgical Removal of Olfactory Groove Meningiomas

Abstract: Our experience with the pterional approach suggests a greater role for this procedure in the treatment of olfactory groove meningiomas.

Cited by 88 publications

References 9 publications

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

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

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

Skull base approaches in the pediatric population

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