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Validity of the frontolateral approach as a minimally invasive corridor for olfactory groove meningiomas

  • Clinical Article
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Abstract

Background

Several approaches are described for olfactory groove meningiomas (OGMs) varying from a very wide bifrontal craniotomy to minimally invasive endoscopic techniques. The goal of this study was to evaluate the results of the frontolateral approach for olfactory groove meningioma. Pitfalls related to this corridor will be described. The impact of tumor size and encasement of the anterior cerebral artery complex on the degree of tumor removal will be described on the basis of experience with 18 cases.

Methods

Eighteen patients with OGM underwent microsurgical removal using the frontolateral approach. A retrospective study was conducted by analyzing clinical data, neuroimaging studies, operative findings, clinical outcome, and degree of tumor removal.

Findings

The patients were classified into group A with tumor size less than 4 cm in diameter (7 out of 18 cases, 38.9%) and group B with tumor size more than 4 cm in diameter (11 out of 18 cases, 61.1%). CSF rhinorrhea was observed in three patients (16.7%). Postoperative left frontal intracerebral hematoma occurred in one patient (5.6%) belonging to group A. In another patient (5.6%) belonging to group B, marked right frontal lobe swelling was evident after dural opening, which necessitated partial right frontal pole resection. Total tumor removal (Simpson grade 1 and 2) was achieved in 14 out of 18 patients (77.8%), while subtotal removal (Simpson grade 3 and 4) was achieved in 4 patients (22.2%). In the 14 patients in whom total removal was achieved, 7 belonged to group A (all 7 patients of group A with 100% removal), while the remaining 7 patients belonged to group B (7 out of 11 patients, 63.6% removal; one of them had anterior cerebral artery complex encasement). The four patients in whom subtotal removal was achieved belonged to group B; three of them showed anterior cerebral artery complex encasement, and one elderly patient had non-extensive paranasal sinus involvement. One patient (5.6%) in group B died from cerebral infarction after subtotal tumor removal with anterior cerebral artery injury during its dissection from the tumor capsule.

Conclusion

The frontolateral approach has the advantages of both the pterional and conventional bifrontal approaches. The frontolateral approach allows quick and minimally invasive access to OGMs less than 4 cm in diameter, and also to tumors more than 4 cm in diameter without encasement of the anterior cerebral artery complex. Tumor size more than 4 cm in diameter and encasement of the anterior cerebral artery complex are limiting factors for the frontolateral approach if radical tumor removal is considered.

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Authors and Affiliations

  1. Department of Neurosurgery, Ain Shams University, Cairo, Egypt

    Khaled El-Bahy

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  1. Khaled El-Bahy
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Correspondence to Khaled El-Bahy.

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Comment

The author reviews his experience with a unilateral frontolateral approach for the removal of olfactory groove meningiomas in 18 cases. Total tumor removal was achieved in 77% of patients. There were three CSF leaks encountered, one postoperative hematoma, and one patient died as a result of anterior cerebral artery injury.

The author experienced no recurrence in these patients over a 31-month mean follow-up period, even in two cases with paranasal sinus tumor involvement. The author provides a nice overview of the benefits and limitations of this approach in comparison to other approaches (bifrontal, pterional). He correctly emphasizes the advantages of this approach for smaller lesions. There is no discussion of the use of transnasal extended approaches, with or without the use of the endoscope, which are being used by some surgeons to remove midline tumors in this location.

W. Couldwell

Utah, USA

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El-Bahy, K. Validity of the frontolateral approach as a minimally invasive corridor for olfactory groove meningiomas. Acta Neurochir 151, 1197–1205 (2009). https://doi.org/10.1007/s00701-009-0369-3

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