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Kurucz P, Ganslandt O, Buchfelder M, Adib SD, Barany L. Anatomy and Microsurgical Relevance of the Outer Arachnoid Envelope around the Olfactory Bulb Based on Endoscopic Cadaveric Observations. J Neurol Surg A Cent Eur Neurosurg 2024. [PMID: 38242165 DOI: 10.1055/a-2249-7710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
BACKGROUND There is high risk of injury to the olfactory tract and olfactory bulb during surgery of the anterior cranial fossa. The goal of this study was to describe the outer arachnoid envelope around the olfactory bulb, which plays a significant role in approach-related injury of the nerve. METHODS A total of 20 fresh human cadaveric heads were examined. Five cadaveric heads were used to describe a gross overview of the topographic anatomy of the outer arachnoid cover of the olfactory bulb. In 15 cadaveric heads, endoscopic surgical approaches were performed to examine the in situ undisrupted anatomy of the outer arachnoid around the olfactory bulb. Four cadaveric heads were used for the lateral subfrontal approach, 5 heads for the medial subfrontal approach, 3 heads for the median subfrontal approach, and 3 heads for the anterior interhemispheric approach. RESULTS The outer arachnoid membrane of the frontal lobe attaches the olfactory bulb strongly to the above lying olfactory sulcus. Only the most rostral portion of the olfactory bulb became slightly detached from the frontal lobe. The outer arachnoid forms a decent protrusion around the tip of the olfactory bulbs. The fila olfactoria have their own outer arachnoid cover as a continuation of the same layer of the olfactory bulb. The effect of brain retraction and manipulation forces on the olfactory bulb and the role of the arachnoid membranes located here were visually analyzed and described in detail through the four different neurosurgical approaches we performed. CONCLUSION The results of our observations provide important anatomical details for preserving the sense of smell during neurosurgical procedures.
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Affiliation(s)
- Peter Kurucz
- Department of Neurosurgery, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
- Department of Neurosurgery, Katharinenhospital, Klinikum Stuttgart, Stuttgart, Germany
| | - Oliver Ganslandt
- Department of Neurosurgery, Katharinenhospital, Klinikum Stuttgart, Stuttgart, Germany
| | - Michael Buchfelder
- Department of Neurosurgery, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
| | - Sasan Darius Adib
- Department of Neurosurgery, University of Tuebingen, Tuebingen, Germany
| | - Laszlo Barany
- Department of Neurosurgery, Friedrich-Alexander-University Erlangen-Nuremberg, Erlangen, Germany
- Laboratory for Applied and Clinical Anatomy, Department of Anatomy, Histology and Embryology, Semmelweis University, Budapest, Hungary
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Khan M, Yoo SJ, Clijsters M, Backaert W, Vanstapel A, Speleman K, Lietaer C, Choi S, Hether TD, Marcelis L, Nam A, Pan L, Reeves JW, Van Bulck P, Zhou H, Bourgeois M, Debaveye Y, De Munter P, Gunst J, Jorissen M, Lagrou K, Lorent N, Neyrinck A, Peetermans M, Thal DR, Vandenbriele C, Wauters J, Mombaerts P, Van Gerven L. Visualizing in deceased COVID-19 patients how SARS-CoV-2 attacks the respiratory and olfactory mucosae but spares the olfactory bulb. Cell 2021; 184:5932-5949.e15. [PMID: 34798069 PMCID: PMC8564600 DOI: 10.1016/j.cell.2021.10.027] [Citation(s) in RCA: 224] [Impact Index Per Article: 74.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/01/2021] [Accepted: 10/25/2021] [Indexed: 12/28/2022]
Abstract
Anosmia, the loss of smell, is a common and often the sole symptom of COVID-19. The onset of the sequence of pathobiological events leading to olfactory dysfunction remains obscure. Here, we have developed a postmortem bedside surgical procedure to harvest endoscopically samples of respiratory and olfactory mucosae and whole olfactory bulbs. Our cohort of 85 cases included COVID-19 patients who died a few days after infection with SARS-CoV-2, enabling us to catch the virus while it was still replicating. We found that sustentacular cells are the major target cell type in the olfactory mucosa. We failed to find evidence for infection of olfactory sensory neurons, and the parenchyma of the olfactory bulb is spared as well. Thus, SARS-CoV-2 does not appear to be a neurotropic virus. We postulate that transient insufficient support from sustentacular cells triggers transient olfactory dysfunction in COVID-19. Olfactory sensory neurons would become affected without getting infected.
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Affiliation(s)
- Mona Khan
- Max Planck Research Unit for Neurogenetics, Frankfurt, Germany
| | - Seung-Jun Yoo
- Max Planck Research Unit for Neurogenetics, Frankfurt, Germany
| | - Marnick Clijsters
- Department of Neurosciences, Experimental Otorhinolaryngology, Rhinology Research, KU Leuven, Leuven, Belgium
| | - Wout Backaert
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Unit, KU Leuven, Leuven, Belgium
| | - Arno Vanstapel
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Kato Speleman
- Department of Otorhinolaryngology, Head and Neck Surgery, AZ Sint-Jan Brugge-Oostende AV, Bruges, Belgium
| | - Charlotte Lietaer
- Department of Otorhinolaryngology, Head and Neck Surgery, AZ Sint-Jan Brugge-Oostende AV, Bruges, Belgium
| | - Sumin Choi
- Max Planck Research Unit for Neurogenetics, Frankfurt, Germany
| | | | - Lukas Marcelis
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Andrew Nam
- NanoString Technologies Inc., Seattle, WA, USA
| | - Liuliu Pan
- NanoString Technologies Inc., Seattle, WA, USA
| | | | - Pauline Van Bulck
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Hai Zhou
- Max Planck Research Unit for Neurogenetics, Frankfurt, Germany
| | - Marc Bourgeois
- Department of Anesthesiology and Intensive Care Medicine, AZ Sint-Jan Brugge-Oostende AV, Bruges, Belgium
| | - Yves Debaveye
- Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Cellular and Molecular Medicine, Laboratory of Intensive Care Medicine, KU Leuven, Leuven, Belgium
| | - Paul De Munter
- Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Microbiology, Immunology and Transplantation, Laboratory for Clinical Infectious and Inflammatory Disorders, KU Leuven, Leuven, Belgium
| | - Jan Gunst
- Intensive Care Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Cellular and Molecular Medicine, Laboratory of Intensive Care Medicine, KU Leuven, Leuven, Belgium
| | - Mark Jorissen
- Department of Neurosciences, Experimental Otorhinolaryngology, Rhinology Research, KU Leuven, Leuven, Belgium; Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Katrien Lagrou
- Department of Laboratory Medicine and National Reference Centre for Respiratory Pathogens, University Hospitals Leuven, Leuven, Belgium; Department of Microbiology, Immunology and Transplantation, Laboratory of Clinical Bacteriology and Mycology, KU Leuven, Leuven, Belgium
| | - Natalie Lorent
- Department of Respiratory Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Arne Neyrinck
- Department of Anesthesia, University Hospitals Leuven, Leuven, Belgium; Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium
| | - Marijke Peetermans
- Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Microbiology, Immunology and Transplantation, Laboratory for Clinical Infectious and Inflammatory Disorders, KU Leuven, Leuven, Belgium
| | - Dietmar Rudolf Thal
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium; Department of Imaging and Pathology, Laboratory of Neuropathology and Leuven Brain Institute, KU Leuven, Leuven, Belgium
| | - Christophe Vandenbriele
- Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium; Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium
| | - Joost Wauters
- Department of General Internal Medicine, University Hospitals Leuven, Leuven, Belgium; Department of Microbiology, Immunology and Transplantation, Laboratory for Clinical Infectious and Inflammatory Disorders, KU Leuven, Leuven, Belgium
| | - Peter Mombaerts
- Max Planck Research Unit for Neurogenetics, Frankfurt, Germany.
| | - Laura Van Gerven
- Department of Neurosciences, Experimental Otorhinolaryngology, Rhinology Research, KU Leuven, Leuven, Belgium; Department of Otorhinolaryngology, Head and Neck Surgery, University Hospitals Leuven, Leuven, Belgium; Department of Microbiology, Immunology and Transplantation, Allergy and Clinical Immunology Research Unit, KU Leuven, Leuven, Belgium.
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Ferroli P, Restelli F, Broggi M. Olfactory nerve sparing technique for anterior skull base meningiomas: how I do it. Acta Neurochir (Wien) 2021; 163:2453-2457. [PMID: 34291382 DOI: 10.1007/s00701-021-04929-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/23/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Olfactory function preservation is a desirable objective in anterior skull base (ASB) surgery. The "infracerebral-supraolfactory nerve" corridor is presented. METHOD The technique for preserving the olfactory nerves (OlfNs) in anterior ASB meningioma removal involves the following points: deep knowledge of the ASB vascular and meningeal anatomy, precise preoperative planning, wide and sharp dissection of the OlfNs away from the frontal lobes, gravity-aided frontal lobe retraction, Gelfoam-assisted hemostasis on nervous structures, and access to the lesion through an infracerebral-supraolfactory nerve corridor. CONCLUSIONS This technique may be a valid option for patients affected by anterior skull base meningiomas with intact preoperative olfactory function.
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Affiliation(s)
- Paolo Ferroli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
| | - Francesco Restelli
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy.
| | - Morgan Broggi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
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Benson JC, Nascene D, Truwit C, McKinney AM. Septo-optic Dysplasia : Assessment of Associated Findings with Special Attention to the Olfactory Sulci and Tracts. Clin Neuroradiol 2018; 29:505-513. [PMID: 29663010 DOI: 10.1007/s00062-018-0687-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 04/02/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE Septo-optic dysplasia is a congenital disorder consisting of optic nerve hypoplasia and absent septum pellucidum. While associated anomalies have been described, olfactory sulcus and bulb-tract hypoplasia have been scantily reported and was the focus of this study. METHODS The picture archival and communications system and radiology information system (PACS-RIS) was searched over 15 years for patients with suspected septo-optic dysplasia (n = 41) and cerebral magnetic resonance imaging (MRI). Included patients had coronal (≤3 mm), axial (≤4 mm), and sagittal (≤4 mm) imaging reviewed by two staff neuroradiologists by consensus. Both olfactory sulcus and bulb-tract hypoplasia were ascribed a grade of 0 (normal) to 3 (complete hypoplasia). Other associated congenital anomalies were recorded, if present. Incidence of anomalies were compared to age-matched and gender-matched control patients. RESULTS Out of 41 septo-optic dysplasia patients 33 were included (mean age = 120.7 months), with 8 excluded due to isolated septum pellucidum absence (n = 5), isolated bilateral optic hypoplasia (n = 2), or inadequate imaging (n = 1). An olfactory sulcus was hypoplastic on one or both sides in 14/33 (42.4%). Olfactory bulb hypoplasia was noted in one or both tracts in 15/33 (45.4%). A significant correlation was found between degree of olfactory sulcal and bulb-tract hypoplasia (ρ = 0.528, p = 0.0009). Other anomalies were: anterior falx dysplasia (n = 16, 48.5%), incomplete hippocampal inversion (n = 14, 42.4%), polymicrogyria (n = 11, 33.3%), callosal complete or partial agenesis (n = 10, 30.3%), schizencephaly (n = 8, 24.2%), ectopic posterior pituitary (n = 6, 18.2%), and nodular heterotopia (n = 4, 12.1%). Of the age-matched control patients 10/33 (30.3%) had at least mild anterior falx hypoplasia, and 1 control patient was noted to have unilateral incomplete hippocampal inversion (IHI); none of the age-matched control patients had olfactory sulcus or bulb-tract hypoplasia. CONCLUSION Olfactory sulcus and bulb-tract hypoplasia are fairly common in septo-optic dysplasia and can be discordant between sides. Of the other associated anomalies, anterior falx dysplasia seems to be the most common.
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Affiliation(s)
- John C Benson
- Department of Radiology, University of Minnesota Medical Center, MMC 292, B‑212 Mayo, 420 DelawareStreet SE, 55455, Minneapolis, MN, USA.
| | - David Nascene
- Department of Radiology, University of Minnesota Medical Center, MMC 292, B‑212 Mayo, 420 DelawareStreet SE, 55455, Minneapolis, MN, USA
| | - Charles Truwit
- Department of Radiology, Hennepin County Medical Center, Minneapolis, MN, USA
| | - Alexander M McKinney
- Department of Radiology, University of Minnesota Medical Center, MMC 292, B‑212 Mayo, 420 DelawareStreet SE, 55455, Minneapolis, MN, USA
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López-Elizalde R, Campero A, Sánchez-Delgadillo T, Lemus-Rodríguez Y, López-González MI, Godínez-Rubí M. Anatomy of the olfactory nerve: A comprehensive review with cadaveric dissection. Clin Anat 2017; 31:109-117. [DOI: 10.1002/ca.23003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 10/16/2017] [Accepted: 10/25/2017] [Indexed: 11/11/2022]
Affiliation(s)
- R. López-Elizalde
- Servicio de Neurocirugía, Hospital General Dr. Valentín Gómez Farías, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado; Guadalajara Jalisco 45100 Mexico
| | - A. Campero
- Servicio de Neurocirugía, Hospital Padilla; Buenos Aires Argentina
| | - T. Sánchez-Delgadillo
- Servicio de Neurocirugía, Hospital General Dr. Valentín Gómez Farías, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado; Guadalajara Jalisco 45100 Mexico
| | - Y. Lemus-Rodríguez
- Módulo de Cirugía Cerebrovascular, Centro Médico 20 de Noviembre, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado; Ciudad de México Mexico
| | - MI. López-González
- Laboratorio de Investigación en Patología, Departamento de Microbiología y Patología; Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara; Guadalajara Jalisco Mexico
| | - M. Godínez-Rubí
- Servicio de Neurocirugía, Hospital General Dr. Valentín Gómez Farías, Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado; Guadalajara Jalisco 45100 Mexico
- Laboratorio de Investigación en Patología, Departamento de Microbiología y Patología; Centro Universitario de Ciencias de la Salud, Universidad de Guadalajara; Guadalajara Jalisco Mexico
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Comparison of Unilateral and Bilateral Craniotomy for the Treatment of Bilateral Middle Cerebral Artery Aneurysms: Anatomic and Clinical Parameters and Surgical Outcomes. World Neurosurg 2017; 108:627-635. [PMID: 28887278 DOI: 10.1016/j.wneu.2017.08.175] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 08/26/2017] [Accepted: 08/28/2017] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare 2 craniotomy approaches (unilateral and bilateral) in terms of anatomic and clinical parameters and surgical outcomes. METHODS Between January 2011 and December 2014, 19 patients with bilateral unruptured middle cerebral artery (MCA) aneurysm were treated with unilateral craniotomy (group 1), and 10 patients were treated with bilateral mini-craniotomy (group 2). We compared demographic data, characteristics of aneurysms, radiologic and clinical parameters, postoperative complications, and surgical outcomes between the 2 groups. RESULTS No statistically significant differences in aneurysm characteristics were found between the 2 groups. Radiologic parameters did not have any influence on surgical outcomes or the incidence of postoperative complications. Group 1 had a higher incidence of olfactory dysfunction (11 of 19; 58%) and residual neck at the contralateral aneurysm (10 of 19; 53%), whereas no patients in group 2 had olfactory dysfunction or residual neck at the contralateral aneurysm. All patients in group 2 had good surgical outcomes (modified Rankin scale score 0). The length of hospital stay was similar in the 2 groups. CONCLUSIONS Bilateral mini-craniotomy for the treatment of bilateral MCA aneurysms was associated with better surgical outcomes and fewer complications. Bilateral mini-craniotomy does not require as much retraction of the frontal lobe to apply a clip completely at the contralateral aneurysm. Therefore, it represents a safe and effective therapeutic option for unruptured bilateral MCA aneurysms.
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Tsutsumi S, Ono H, Yasumoto Y. Visualization of the olfactory nerve using constructive interference in steady state magnetic resonance imaging. Surg Radiol Anat 2016; 39:315-321. [PMID: 27506829 DOI: 10.1007/s00276-016-1731-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 08/04/2016] [Indexed: 11/28/2022]
Abstract
PURPOSE The olfactory nerve (OlfN) is a small neural structure with inconsistent visualization on neuroimages. The aim of this study was to delineate the intracranial course of the OlfN using constructive interference in steady state magnetic resonance (MR) imaging. METHODS A total of 168 patients were enrolled in this study. Following initial examinations with conventional MR sequences, constructive interference in steady-state sequence (CISS) was performed in coronal and axial sections. RESULTS On coronal sections, the OlfN was entirely visualized in 90 % of patients on the right and 92 % on the left, coursing along the olfactory sulcus. Complete visualization of the OlfN occurred in 100 % of patients on serial axial images. The OlfN was classified into four portions based on the topographical differences and surrounding structures. The olfactory fossa exhibited considerable variability at the midlevel of the olfactory bulb on coronal images. Characteristic appearance of the OlfN with respect to age range or gender was not observed. CONCLUSIONS The OlfN follows a highly consistent course along the olfactory sulcus. Thin-sliced, CISS sequences are useful for consistent visualization of the OlfN.
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Affiliation(s)
- Satoshi Tsutsumi
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan.
| | - Hideo Ono
- Division of Radiological Technology, Medical Satellite Yaesu Clinic, Tokyo, Japan
| | - Yukimasa Yasumoto
- Department of Neurological Surgery, Juntendo University Urayasu Hospital, 2-1-1 Tomioka, Urayasu, Chiba, 279-0021, Japan
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Hannequin P, Paviot A, Chaussy O, Gilard V, Cébula H, Marie JP, Proust F. Olfaction preservation after removal of large tuberculum sellae meningiomas via a superior interhemispheric approach. A quantitative and qualitative study. Neurochirurgie 2015; 61:318-23. [DOI: 10.1016/j.neuchi.2015.06.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 05/28/2015] [Accepted: 06/07/2015] [Indexed: 10/23/2022]
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Hendrix P, Griessenauer CJ, Foreman P, Shoja MM, Loukas M, Tubbs RS. Arterial supply of the upper cranial nerves: A comprehensive review. Clin Anat 2014; 27:1159-66. [DOI: 10.1002/ca.22415] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 04/18/2014] [Accepted: 04/23/2014] [Indexed: 11/12/2022]
Affiliation(s)
- Philipp Hendrix
- Division of Neurosurgery; Department of Surgery; University of Alabama at Birmingham; Birmingham Alabama
| | - Christoph J. Griessenauer
- Division of Neurosurgery; Department of Surgery; University of Alabama at Birmingham; Birmingham Alabama
| | - Paul Foreman
- Division of Neurosurgery; Department of Surgery; University of Alabama at Birmingham; Birmingham Alabama
| | | | - Marios Loukas
- Department of Anatomical Sciences; St. George's University; Grenada
| | - R. Shane Tubbs
- Pediatric Neurosurgery; Children's Hospital; Birmingham Alabama
- Department of Anatomical Sciences; St. George's University; Grenada
- Centre for Anatomy and Human Identification, Dundee University; United Kingdom
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Curey S, Derrey S, Hannequin P, Hannequin D, Fréger P, Muraine M, Castel H, Proust F. Validation of the superior interhemispheric approach for tuberculum sellae meningioma: clinical article. J Neurosurg 2012; 117:1013-21. [PMID: 23061383 DOI: 10.3171/2012.9.jns12167] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The objective of this study was to evaluate the ophthalmological outcome, nonvisual morbidity, and surgical complications after tuberculum sellae meningioma (TSM) removal using a superior interhemispheric approach. METHODS In the last decade, 20 consecutive patients with TSM underwent operations using the superior interhemispheric approach. Visual acuity, visual field, and ocular fundus examination were assessed both preoperatively and 6-months postoperatively. Nonvisual morbidity was determined at an early postoperative period and at 6 months based on assessment of the Karnofsky Performance Scale score, leakage of CSF, endocrinological status, and olfactory function, which was assessed using a visual analog scale (VAS). The potential brain injury related to the approach was assessed by MRI at 6 months. Magnetic resonance imaging was then performed yearly to detect a recurrence. The mean follow up was 56.3 ± 34 months. RESULTS The primary presenting symptom for diagnosis of TSM in 20 patients (female:male ratio of 6.6:1, mean age 59.1 ± 11.1 years) was visual disturbance in 12 patients (60%), headache in 4 (20%), cognitive alteration in 1 (5%), epilepsy in 2 (10%), and accidental in 1 (5%). In a total of 40 eyes, 17 eyes in 11 patients presented with preoperative deterioration of visual acuity. Postoperatively, the visual acuity improved in 13 eyes in 8 patients (72.8%), remained unchanged in 3 eyes in 2 patients (18.2%) and deteriorated in 1 patient (9%). The nonvisual morbidity included olfactory deterioration in 7 patients (35%), and panhypopituitarism in 1 patient (5%). No patients experienced a CSF leak. The impact of olfactory deterioration on the quality of life, as estimated by a VAS score (range 0-10), was a mean of 5.7 ± 2.2 (95% CI 4.1-7.3). On the follow-up MRI, no additional lesions or recurrences were observed on the medial aspect of the frontal lobe along the surgical corridor. CONCLUSIONS The superior interhemispheric approach appears to be effective in resolving the problem of visual deterioration due to a TSM, without inducing surgical injury on the brain surface along the surgical corridor. Olfactory deterioration remained the challenging predominant nonvisual morbidity using this approach.
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Affiliation(s)
- Sophie Curey
- Department of Neurosurgery, Rouen University Hospital, Rouen, France
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Inci S, Akbay A, Ozgen T. Bilateral middle cerebral artery aneurysms: a comparative study of unilateral and bilateral approaches. Neurosurg Rev 2012; 35:505-17; discussion 517-8. [PMID: 22580988 DOI: 10.1007/s10143-012-0392-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Revised: 03/07/2012] [Accepted: 03/07/2012] [Indexed: 11/25/2022]
Abstract
The best surgical method for the treatment of patients with bilateral middle cerebral artery (bMCA) aneurysms has not been fully determined yet. The main purpose of this study is to compare the surgical results of unilateral and bilateral approaches to bMCA aneurysms including mean operation time, mean hospital stay, and mean cost, in the experience of the same neurosurgical team. Between January 2001 and June 2010, 22 patients with bMCA aneurysms were surgically treated in our institution. In 12 cases (54.5 %), ipsilateral and contralateral MCA aneurysms were successfully clipped via unilateral approach. In the remaining 10 cases, bilateral approach was necessary because of some technical difficulties. Although the surgical results were almost the same, mean operation time and mean hospital stay were, respectively, 46 and 37 % shorter and mean cost per person was 23 % lower for the patients in the unilateral group. In addition, the severity of brain edema, total length of the contralateral (A1+M1) segment, and the configuration of contralateral aneurysm were found to be the determinant parameters affecting the feasibility of the unilateral approach. To our knowledge, this is the first study in the literature that compares the clinical outcomes of unilateral and bilateral approaches to bMCA aneurysms. The results of surgery for both approaches are almost the same. However, the unilateral approach has certain advantages compared to the bilateral approach. Therefore, the unilateral approach may be a good alternative in surgical management of patients with bMCA aneurysms in selected cases and the abovementioned parameters can help the neurosurgeon in patient selection.
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Affiliation(s)
- Servet Inci
- Department of Neurosurgery, School of Medicine, University of Hacettepe, Ankara, Turkey.
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Wang SS, Zheng HP, Zhang X, Zhang FH, Jing JJ, Wang RM. Microanatomy and surgical relevance of the olfactory cistern. Microsurgery 2008; 28:65-70. [DOI: 10.1002/micr.20448] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Cardali S, Romano A, Angileri FF, Conti A, La Torre D, de Divitiis O, d'Avella D, Tschabitscher M, Tomasello F. Microsurgical anatomic features of the olfactory nerve: relevance to olfaction preservation in the pterional approach. Neurosurgery 2006; 57:17-21; discussion 17-21. [PMID: 15987566 DOI: 10.1227/01.neu.0000144844.72403.7b] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2004] [Accepted: 08/13/2004] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The pterional approach represents the standard approach for most lesions of the anterior and middle cranial fossa. It requires some degree of frontal lobe retraction, which may result in temporary or permanent damage of olfaction because of nerve avulsion or mechanical compression. The purpose of this study, based on microanatomic dissection of human cadaveric specimens, was to review the microsurgical anatomic features of the nerve and suggest operative nuances that may contribute to reducing the rate of postoperative olfactory dysfunction. METHODS Twenty olfactory nerves and tracts were examined in 10 human cadaveric heads obtained from three fresh and seven formalin-fixed adult cadavers. A standard pterional craniotomy was performed. The olfactory nerve was dissected from its arachnoidal envelopes and then mobilized for an average length of 30 mm (range, 25-35 mm). RESULTS The possible retraction of the frontal lobe was 10 to 15 mm. More retraction invariably resulted in nerve disruption. CONCLUSION The standard sylvian and basal cistern opening may be insufficient to guarantee preservation of olfactory function. Early identification and arachnoidal dissection of the nerve may reduce the rate of olfaction compromise. The opening of the subarachnoidal space should be performed in a proximal-to-distal manner to allow early visualization of the olfactory bulb and its dissection. The arachnoidal dissection should be performed with sharp instruments, avoiding any traction on the posterior portion of the olfactory tract. Any direct retractor compression should also be avoided to spare the microvasculature lying on the dorsal surface of the nerve.
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Affiliation(s)
- Salvatore Cardali
- Neurosurgical Clinic, Department of Neurosciences, University of Messina Medical School, Messina, Italy
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