Giant olfactory groove meningiomas: advantages of the bilateral fronto-orbitonasal approach

Olfactory groove meningiomas are usually considered surgically curable, but the operation becomes complex when the tumour reaches massive size and involves vital suprasellar structures, extends into the ethmoid sinuses or extensively involves the bony floor of the anterior fossa. The traditional bifrontal approach provides only limited exposure in these situations, and a bilateral fronto-orbitonasal approach may be more effective. We reviewed our experience in five patients with resections of massive olfactory groove meningiomas to assess the advantages and risks of these two approaches. All patients were women (mean age, 45 years; range, 28-59) presenting with symptoms and signs related to increased intracranial pressure, cranial nerve impairment or brain compression. Computed tomography, magnetic resonance imaging and cerebral angiography were used for diagnosis and operative planning. The approach was bifrontal in two patients and bifronto-orbitonasal in three. Total surgical removal (Simpson grade I, three patients; Simpson grade II, one patient) was achieved in four patients (80%) and subtotal tumour removal (Simpson grade III) was performed in one (20%). One patient had two staged operations. No morbidity or mortality occurred in this series. No clinical or radiologic evidence of recurrence developed in the four patients whose tumour was resected totally. The bilateral fronto-orbitonasal approach resulted in safe and successful total removal of giant olfactory groove meningiomas, achieving long-term prevention of recurrence. We highly recommend this approach. Copyright 1999 Harcourt Publishers Ltd.