Artikel
Strategies for the operative therapy of olfactory groove meningiomas
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Veröffentlicht: | 4. Juni 2012 |
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Gliederung
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Objective: Several approaches have been proposed for microsurgical removal of olfactory groove meningiomas. The bifrontal and the orbitozygomatic approach are preferred by many with the disadvantage of sinus opening and extensive bone work. We alternatively used the pterional approach and the anterior interhemispheric approach to resect the tumor. It is our objective to compare the approaches with respect to operative results and complications.
Methods: A total of 62 patients underwent removal of an olfactory groove meningioma. In 28 patients, the right pterional and in the remaining 34 patients, the anterior interhemispheric approach was used. The case files were retrospectively reviewed with focus on clinical outcome, complication rate and tumor remnants.
Results: Using the pterional approach, complete tumor removal was achieved in 27 of 28 patients. In 6 of 8 patients, the visual field cuts and in 19 of 20 patients, the mental dysfunction improved after surgery. Two serious complications (symptomatic rebleed n=1, pulmonary embolism n=1) (7%) occurred. With the interhemispheric approach, complete tumor removal was possible in all patients, leading to visual field cut improvement in 4 of 5 patients and to mental dysfunction improvement in 11 of 12 patients. Wound infection, unrelated brain stem infarction and symptomatic rebleed complicated the postoperative course of 3 patients (9%).
Conclusions: Both approaches to olfactory groove meningiomas allow obtaining favorable surgical results. In comparison with other studies, the complication rate is low. Today, our preferred approach is the interhemispheric approach because of earlier devascularisation, better bilateral control of vital neurovascular structures and better visualisation of the tumor matrix.