Surgical Management of Olfactory Groove Meningiomas

Abstract

Objective: To study the bifrontal approach to olfactory groove meningiomas (OGM), the technique, outcomes, and recurrence rates in a series of 23 cases of OGM operated on during the period between 2000 and 2009.

Methods: The study included twenty three patients with OGM, 15 females and 8 males. The age ranged from 26 years to 65 years with a mean of 45.2 years. Bifrontal craniotomy and excision of tumor was done for all patients.

Results: Tumor diameter varied from 3.3 to 6.1 cm (mean 4.7 cm). Total tumor removal (Simpson grade 1 and 2) was achieved in twenty patients (86.9%) and subtotal removal (Simpson grade 3) was achieved in three patients (13.1%), in whom the anterior cerebral artery complex was encased. The pathology in all patients was Grade I meningiomas (World Health Organization grading). There was no operative mortality. Anosmia occurrygered in all but three patients and partial left optic injury in one patient. Three patients suffered post operative cerebrospinal fluid rhinorrhea which stopped in all after repeated lumbar drainage. Three patients suffered postoperative wound infection and responded well to appropriate antibiotic treatment. There was one recurrence in the follow up period of 6 months to 8 years with a mean of 2.6 years.

Conclusion: A variety of surgical approaches are used for OGM resection. Bifrontal approach offers excellent exposure, and when combined with modern microsurgical cranial base techniques allows maximum safety during surgery with minimal permanent morbidity, excellent neurological outcome, and very low recurrence rates