gms | German Medical Science

Objective: Olfactory groove meningiomas arise over the cribriform plate and comprise approximately 10% of intracranial meningiomas. The blood supply of these lesions derives most commonly from the anterior or posterior ethmoidal arteries. By virtue of their location olfactory groove meningiomas may reach considerable size prior to clinical presentation. Typical neurological findings apart from anosmia are visual disturbances, loss of intellectual functions and memory disturbances.

Methods: We reviewed the charts of 78 patients - 36 females and 42 males - with olfactory groove meningiomas in an age range of 37-84 years. Preoperative diagnosis included computed tomography and magnetic resonance imaging and a conventional or CT angiography. Tumour resection was achieved either via a pterional craniotomy (34 cases), through a bifrontal craniotomy (9 cases) leaving the frontal sinus intact or via a subfrontal approach (7 cases) and in 28 patients via an interhemispheric access. The surgical treatment included an excision of tumour, the involved dura of the anterior fossa and hyperostotic bone to minimise the risk of recurrence.

Results: Total removal was achieved in 74 of 78 patients and subtotal 4. One patient with a tumour relapse had an atypical meningioma and one female suffered from a meningiomatosis. Considering any approach, the following strategies must be embarked: early interruption of blood supply, atraumatic dissection of anterior cerebral arteries, optic nerves, chiasm and excellent visualisation of the anterior cranial fossa. In the group with tumour resection via a pterional approach the postoperative course was complicated by visual loss (n=1), a symptomatic re-bleeding (n=1) and death (n=1). In patients operated by a frontal exposure, one CSF leakage occurred 5 months after surgery. The clinical course of patients with an interhemispheric approach was complicated by one postoperative wound infection, one asymptomatic re-bleeding and one fatal outcome.

Conclusions: Despite the fact that olfactory groove meningiomas may become very large before they cause neurological deficits, resection provides very satisfying results. In our series, both the subfrontal and interhemispheric approach seem to be associated with minor surgical complications.