Unilateral frontal approaches for the removal of large bilateral olfactory groove meninjiomas_West China Medical Journal

Authors：

ZHANG Yang ,  ZHOU Liangxue , XU Jianguo , CAI Bowen , JIANG Shu , LIU Yi , YOU Chao

Department of Neurosurgery, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding?author：

ZHOU Liangxue, Email: zhoulxlll@163.com

Keywords：

Bilatera olfactory groove meningioma; Subfrontal approach; Microsurgery; Reconstruction of skull base

DOI：

10.7507/1002-0179.201805163

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ObjectiveTo investigate the effect of microsurgical therapy and the key techniques in resection of large bilateral olfactory groove meningiomas via unilateral subfrontal approach.MethodsThe clinical data and follow-up results of 181 patients with large bilateral olfactory groove meningiomas who underwent microsurgical removal between June 2007 and May 2014 were retrospectively analyzed. The initial symptom was headache or (and) dizzy in 95 cases, hyposmia or anosmia in 53, impairment of visual function or (and) visual field deficits in 26, cognitive deficits in 3, epilepsy in 2, and accidentally discovered in 2. Unilateral subfrontal approach was applied in all patients (neuroendoscopy was applied in some cases in the later period); incision of falxcerebri, and when necessary, ligation of superior sagittal sinus to resect contralateral tumor were performed. Simultaneous or staged period resection of tumors invading skull base such as ethmoid sinus and superior meatus and reconstruction of the skull base were performed.ResultsThere was no perioperative mortality. Simpson grade Ⅰ resection was obtained in 33 cases, grade Ⅱ resection was in 141, grade Ⅲ resection was in 4, and grade Ⅳ resection was in 3. Among the 229 eyes with preoperative visual impairment, postoperative visual improvement was found in 215 eyes, unimproved was in 12, and aggravation was in 2. The 59 sides which lost their function of olfactory nerve before surgery obtained no recoveries after surgery, while olfactory nerve with residual function preoperative still kept sensing after surgery in 149 lateral sides (149/303). The patients were followed up for (76.9±43.8) months, and postoperative recurrence or residual tumor growth were found in 21 cases.ConclusionsBecause of the contralateral ocular and (or) nasal compensation, early discovery is very difficult for patients with olfactory groove meningioma. The unilateral subfrontal approach can provide sufficient exposure for resection of large bilateral olfactory groove meningiomas and improve the visual acuity and visual field deficits. But it is poor at the preservation of olfactory function. The approach, better with the aid of neuroendoscopy, can improve the total cutting rate, with the advantages of minimally invasion and fewer complications. It is a worthy priority for these tumors.

Citation： ZHANG Yang, ZHOU Liangxue, XU Jianguo, CAI Bowen, JIANG Shu, LIU Yi, YOU Chao. Unilateral frontal approaches for the removal of large bilateral olfactory groove meninjiomas. West China Medical Journal, 2018, 33(6): 714-718. doi: 10.7507/1002-0179.201805163 Copy

1.	Spektor S, Valarezo J, Fliss DM, et al. Olfactory groove meningiomas from neurosurgical and ear, nose, and throat perspectives: approaches, techniques, and outcomes. Neurosurgery, 2005, 57(4 Suppl): 268-280.
2.	田凱兵, 郝淑煜, 吳震. 嗅溝腦膜瘤的臨床研究進展. 國際神經病學神經外科學雜志, 2014, 41(2): 174-177.
3.	Bassiouni H, Asgari S, Stolke D. Olfactory groove meningiomas: functional outcome in a series treated microsurgically. Acta Neurochir (Wien), 2007, 149(2): 109-121.
4.	葉應湖, 陳治標, 劉仁忠, 等. 嗅溝腦膜瘤的顯微外科治療. 中國臨床神經外科雜志, 2004, 9(5): 9-11.
5.	Nakamura M, Struck M, Roser F, et al. Olfactory groove meningiomas: clinical outcome and recurrence rates after tumor removal through the frontolateral and bifrontal approach. Neurosurgery, 2007, 60(5): 844-852.
6.	Heald JB, Carroll TA, Mair RJ. Simpson grade: an opportunity to reassess the need for complete resection of meningiomas. Acta Neurochir (Wien), 2014, 156(2): 383-388.
7.	Louis DN, Perry A, Reifenberger G, et al. The 2016 World Health Organization classification of tumors of the central nervous system: a summary. Acta Neuropathol, 2016, 131(6): 803-820.
8.	Fountas KN, Hadjigeorgiou GF, Kapsalaki EZ, et al. Surgical and functional outcome of olfactory groove meningiomas: Lessons from the past experience and strategy development. Clin Neurol Neurosurg, 2018, 171: 46-52.
9.	Musluman AM, Yilmaz A, R TC, et al. Unilateral frontal interhemispheric transfalcial approaches for the removal of olfactory groove meninjiomas. Turk Neurosurg, 2012, 22(2): 174-182.
10.	Ciurea AV, Iencean SM, Rizea RE, et al. Olfactory groove meningiomas: a retrospective study on 59 surgical cases. Neurosurg Rev, 2012, 35(2): 195-202; discussion 202.
11.	梁日生, 周良輔, 毛穎, 等. 嗅溝腦膜瘤的顯微外科治療. 中華腫瘤雜志, 2011, 33(1): 70-74.
12.	蔡博文, 周良學, 安惠民, 等. 顱鼻溝通性腫瘤一期聯合手術及顱底重建的早期療效. 中國修復重建外科雜志, 2008, 22(5): 589-592.

1. Spektor S, Valarezo J, Fliss DM, et al. Olfactory groove meningiomas from neurosurgical and ear, nose, and throat perspectives: approaches, techniques, and outcomes. Neurosurgery, 2005, 57(4 Suppl): 268-280.
2. 田凱兵, 郝淑煜, 吳震. 嗅溝腦膜瘤的臨床研究進展. 國際神經病學神經外科學雜志, 2014, 41(2): 174-177.
3. Bassiouni H, Asgari S, Stolke D. Olfactory groove meningiomas: functional outcome in a series treated microsurgically. Acta Neurochir (Wien), 2007, 149(2): 109-121.
4. 葉應湖, 陳治標, 劉仁忠, 等. 嗅溝腦膜瘤的顯微外科治療. 中國臨床神經外科雜志, 2004, 9(5): 9-11.
5. Nakamura M, Struck M, Roser F, et al. Olfactory groove meningiomas: clinical outcome and recurrence rates after tumor removal through the frontolateral and bifrontal approach. Neurosurgery, 2007, 60(5): 844-852.
6. Heald JB, Carroll TA, Mair RJ. Simpson grade: an opportunity to reassess the need for complete resection of meningiomas. Acta Neurochir (Wien), 2014, 156(2): 383-388.
7. Louis DN, Perry A, Reifenberger G, et al. The 2016 World Health Organization classification of tumors of the central nervous system: a summary. Acta Neuropathol, 2016, 131(6): 803-820.
8. Fountas KN, Hadjigeorgiou GF, Kapsalaki EZ, et al. Surgical and functional outcome of olfactory groove meningiomas: Lessons from the past experience and strategy development. Clin Neurol Neurosurg, 2018, 171: 46-52.
9. Musluman AM, Yilmaz A, R TC, et al. Unilateral frontal interhemispheric transfalcial approaches for the removal of olfactory groove meninjiomas. Turk Neurosurg, 2012, 22(2): 174-182.
10. Ciurea AV, Iencean SM, Rizea RE, et al. Olfactory groove meningiomas: a retrospective study on 59 surgical cases. Neurosurg Rev, 2012, 35(2): 195-202; discussion 202.
11. 梁日生, 周良輔, 毛穎, 等. 嗅溝腦膜瘤的顯微外科治療. 中華腫瘤雜志, 2011, 33(1): 70-74.
12. 蔡博文, 周良學, 安惠民, 等. 顱鼻溝通性腫瘤一期聯合手術及顱底重建的早期療效. 中國修復重建外科雜志, 2008, 22(5): 589-592.

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