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Surgical treatment of olfactory groove meningioma - bifrontal interhemispheric vs unilateral approach
EANS Academy. Lee S. Sep 27, 2019; 276068; EP04028
Abstract
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Background: The surgical approach to olfactory groove meningiomas can vary depending in the size and expansion of the tumor. The authors retrospectively analyzed the clinical presentation and the surgical outcome of the patients with huge olfactory groove meningioma and described the advantage of bifrontal interhemspheric and unilateral subfrontal and/or pterional approach.
Methods: Since 1997, a series of 33 consecutive patients with olfactory groove meningioma underwent microsurgical resection using interhemispheric approach via bifrontal craniotomy and subfrontal and/or pterional approach using unilateral craniotomy. The tumor diameter measured 4.5cm in average. The clinical presentation included headache in 18, visual impairment in 4, mental dysfunction in 2, seizure in 2. Mean duration of the clinical history was 7 months.
Results: The patient´s age ranged from 29 to 57 years old with an average age of 43. Nineteen were in female and fourteen in male. The grade of resection was Simpson II In 30 cases, III in 3 cases. The majority of the cases presented a typical histology ; 23 meningiothelial, 7 transitional, 3 angiomatous. All of patients presented a good recovery at discharge. Three of the cases with small remnant tumor and one with a tumor recurrence after follow - up of 19 months were treated by Gamma knife radiosurgery.
Conclusions: Our experience with bifrontal interhemispheric approach suggests a great surgical outcome in the treatment of huge size olfactory groove meningioma and there was no postoperative infection and no cosmetic problems. This approach enabled us to minimize frontal lobe retration, to interrupt the blood supply to the tumor early, and to remove the tumor completely from the frontal base. Unilateral subfrontal and/or pterional approach is helpful in small and medium-size tumor. It reduced frontal lobe retraction which minimized post-operative psychologic problem and spared at least one olfactory nerve function.
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