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Microsurgical Removal of Olfactory Groove Meningiomas via the Pterional Approach
Abstract:
Commonly used frontobasal approaches for microsurgical removal of olfactory groove meningiomas have certain disadvantages, such as late exposure of the neurovascular complex located dorsal to the tumor, namely, the internal carotid artery, middle cerebral artery, anterior cerebral artery, and the optic nerves. In addition, the frontal sinuses are frequently opened and there can be compression of the frontal lobes from significant spatula pressure. We report our experience with the pterional approach for these tumors in 28 patients. All patients presented with hyposmia/anosmia; 20 had personality changes and 8 had visual deficits. At surgery, after dissection of the sylvian fissure, the internal carotid artery, middle cerebral artery, anterior cerebral artery, and the homolateral optic nerve were exposed before removal of the posterior tumor parts. Reduction of focal pressure was achieved by removal of the contralateral tumor following partial resection of the falx and crista galli. Total tumor removal was obtained in all but 1 patient. One patient died of pulmonary embolism. The psychoorganic syndrome resolved in all but 1 patient; visual deficits improved in 6 patients. There were no postoperative infections. We consider the pterional approach to be superior to others for these lesions because it provides early exposure of the neurovascular complex, preservation of the frontal venous drainage, and avoidance of postoperative cerebrospinal fluid fistulae.
Insights
The pterional approach offers superior microsurgical removal of olfactory groove meningiomas, providing early neurovascular exposure and better patient outcomes compared to frontobasal methods. This technique minimizes frontal lobe compression and avoids sinus complications.
Area of Science:
- Neurosurgery
- Oncology
Background:
- Olfactory groove meningiomas often present with neurological deficits.
- Frontobasal surgical approaches carry risks like delayed neurovascular exposure and frontal lobe injury.
Purpose of the Study:
- To evaluate the efficacy and safety of the pterional approach for olfactory groove meningioma resection.
- To compare the pterional approach with traditional frontobasal methods.
Main Methods:
- Retrospective analysis of 28 patients undergoing pterional approach for olfactory groove meningiomas.
- Detailed surgical technique description including sylvian fissure dissection and tumor removal strategy.
- Assessment of pre- and post-operative symptoms and outcomes.
Main Results:
- Total tumor removal was achieved in 27 out of 28 patients.
- Significant improvement in psychoorganic syndrome and visual deficits observed.
- Early exposure of critical neurovascular structures (internal carotid artery, middle cerebral artery, anterior cerebral artery, optic nerves) was achieved.
Conclusions:
- The pterional approach is a safe and effective method for olfactory groove meningiomas.
- It offers advantages over frontobasal approaches, including early neurovascular complex exposure and reduced complications.
- This technique leads to favorable patient outcomes and fewer postoperative issues.
