Trans-Frontal-Sinus-Subcranial Approach to Olfactory Groove Meningiomas: Surgical Results, Clinical and Functional Outcome in A Consecutive Series of 21 Patients.

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Trans-Frontal-Sinus-Subcranial Approach to Olfactory Groove Meningiomas: Surgical Results, Clinical and Functional Outcome in A Consecutive Series of 21 Patients.

World Neurosurg. 2017 Feb 14;:

Authors: Barzaghi LR, Spina A, Gagliardi F, Boari N, Mortini P

Abstract
BACKGROUND: The trans-frontal-sinus-subcranial approach (TFSSA) allows for direct exposure and removal of olfactory groove meningiomas (OGMs), without any brain retraction. Compared to other skull base approaches (like fronto-orbito-basal, transbasal, subcranial, fronto-orbito-zygomatic and one-and-half approach), it could offer the same advantages but it is less invasive.
OBJECT: We report the results in a series of 21 consecutive patients harboring OGMs and operated through TFSSA, in order to propose a viable alternative approach.
METHODS: Mean maximum tumor diameter was 45.9 ± 3.4 mm (25-70). Aim of surgery was Simpson Grade I removal. Surgical, clinical and functional outcomes were reported. Mean follow-up was 87 ± 7 months (36-176).
RESULTS: In all patients, MRI after surgery confirmed complete tumor removal. The recurrence-free survival rate was 100% and 85.7% at 5 and 10 years, respectively. Surgery-related mortality and major morbidity were 0 and 4.8%, respectively. Risk of anosmia significantly correlates with meningioma size (p<.001) and smell sense was preserved only in patients harboring tumors less than 4 cm in maximum diameter (4/7 57.1%). A significant improvement of Mini Mental Standard Examination score was recorded at follow-up (p<.001) and no patients worsened their cognitive profile. Visual function improved in 7/8 (87.5%). Karnofsky Performance Scale after surgery significantly increased (p<.001). According to the Glasgow outcome score, good outcome was achieved in 20 patients (95.2%).
CONCLUSIONS: Based on reported results, TFSSA allows complete tumor removal with good outcome and low complication rate. It may be proposed as a safe and effective approach to treat large and giant OGMs.

PMID: 28213192 [PubMed - as supplied by publisher]

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