Endoscopic Transcaruncular Approach for Early Anterior Ethmoidal Artery Cauterization in Large Olfactory Groove...

Large olfactory groove meningiomas (OGMs) derive their primary blood supply from the anterior and posterior ethmoidal arteries (AEA/PEA), which are inaccessible early during conventional subfrontal craniotomy, resulting in massive intraoperative hemorrhage. A 61-year-old man presented with altered consciousness and incoherent speech, which revealed a giant anterior skull-base meningioma with bilateral optic nerve encasement and ethmoid sinus invasion, with digital subtraction angiography confirming bilateral AEA/PEA as the dominant feeder. We used a staged hybrid strategy in which bilateral AEA cauterization through an endoscopic transcaruncular approach was performed before bifrontal craniotomy. This staged devascularization markedly reduced intraoperative hemorrhage and facilitated near-total resection. Histopathology confirmed an atypical meningioma, and 2-year follow-up MRI revealed no recurrence. Single-staged hybrid surgery incorporating endoscopic transcaruncular AEA cauterization is a safe and minimally invasive adjunct for large OGM surgery.