1
|
Kasper EM, Mirza FA, Kaya S, Walker R, Starnoni D, Daniel RT, Nair R, Lam FC. Surgical Morbidity in Relation to the Surgical Approach for Olfactory Groove Meningiomas-A Pooled Analysis of 1016 Patients and Proposal of a New Reporting System. Brain Sci 2023; 13:896. [PMID: 37371375 DOI: 10.3390/brainsci13060896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 05/23/2023] [Accepted: 05/27/2023] [Indexed: 06/29/2023] Open
Abstract
Background: There is currently no consensus in the field regarding whether a frontal or lateral approach is superior for microsurgical resection of olfactory groove meningiomas (OGM). Due to the lack of uniformity in classifying lesions and inherent differences in reporting outcomes after varying operative approaches, the best practice for approaching these lesions is yet to be determined. Objective: This study aimed to assess various surgical approaches undertaken for OGMs, investigate procedural aspects influencing the extent of resection, and analyze the respective complication rate associated with each approach. We performed a comprehensive literature review of presenting signs and symptoms in OGM patients, their surgical management, and the reported surgical outcomes. To address the lack of uniform data reporting across studies and to take more recent translational studies into account, we developed a new classification system for OGMs that can remedy the existing deficiencies in comparability of reporting. Methods: We conducted a PRISMA-guided literature search for surgical reports on OGMs published in the MRI era using broad search terms such as 'olfactory groove meningioma' and 'surgery', which yielded 20,672 results. After title screening and removal of duplicates, we assessed 871 studies on the specific surgical management of olfactory groove meningiomas. Following the application of exclusion criteria and abstract screening, a set of 27 studies was chosen for the final analysis of a pooled cohort of these reported patient outcomes. Results: The final twenty-seven studies included in our in-depth analysis identified a total of 1016 individual patients who underwent open microsurgical resection of OGMs. The approaches used included: pterional/unilateral, bifrontal with variations, and anterior interhemispheric approaches. Across all studies, gross total resection (Simpson Grades I or II) was achieved in 91.4% of cases, and subtotal resection (Grades III and IV) was reported in 8.6% of cases. A cumulative twenty-seven percent of surgical OGM patients sustained some form of complications. Minor issues accounted for 22.2% (CSF leak, seizures, infection, transient cranial nerve palsies, hydrocephalus), whereas major issues comprised 4.7% (hemorrhage, ischemic infarct, malignant cerebral edema). We then examined the correlation between these complications and the surgical approach chosen. Among pooled cohort of 426 patients who underwent unilateral approaches, 14% experienced minor complications, and 2.1% experienced major complications. For the mixed cohort of 410 patients who underwent bifrontal approaches, 24.6% experienced minor complications, and 7% experienced major complications. Conclusions: Unilateral approaches appear to have lower complication rates for the resection of OGMs compared to bilateral approaches. However, the extent of resection is not uniformly reported, making it difficult to identify differences. The use of an improved preoperative classification and scoring system can help establish a more coherent system to select the most suitable approach and to uniformly report surgical outcomes, such as EOR and complication rates specific to a given OGM and its surgical approach.
Collapse
Affiliation(s)
- Ekkehard M Kasper
- Department of Neurosurgery, St. Elizabeth's Medical Center, Brighton, MA 02135, USA
- Dana Farber Cancer Institute, Boston, MA 02215, USA
- Boston University School of Medicine, Boston, MA 02118, USA
- Division of Neurosurgery, Hamilton General Hospital, McMaster University Faculty of Health Sciences, Hamilton, ON L8L 2X2, Canada
| | - Farhan A Mirza
- Department of Neurosurgery, University of Kentucky, Lexington, KY 40536, USA
| | - Serdar Kaya
- Department of Neurosurgery, St. Elizabeth's Medical Center, Brighton, MA 02135, USA
- Dana Farber Cancer Institute, Boston, MA 02215, USA
| | - Robert Walker
- Department of Neurosurgery, St. Elizabeth's Medical Center, Brighton, MA 02135, USA
- Dana Farber Cancer Institute, Boston, MA 02215, USA
| | - Daniele Starnoni
- Neurosurgery Service, Centre Hospitalier Universitaire Vaudois/University of Lausanne, CH-1011 Lausanne, Switzerland
| | - Roy T Daniel
- Neurosurgery Service, Centre Hospitalier Universitaire Vaudois/University of Lausanne, CH-1011 Lausanne, Switzerland
| | - Ramesh Nair
- Neurosurgery Service, Charing Cross Hospital, Imperial College London, London W6 8RF, UK
| | - Fred C Lam
- Department of Neurosurgery, St. Elizabeth's Medical Center, Brighton, MA 02135, USA
- Dana Farber Cancer Institute, Boston, MA 02215, USA
- Boston University School of Medicine, Boston, MA 02118, USA
- Harvey Cushing Neuro-Oncology Laboratories, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
| |
Collapse
|
2
|
Champagne PO, Zenonos GA, Wang EW, Snyderman CH, Gardner PA. The Evolution of Endoscopic Endonasal Approach for Olfactory Groove Meningiomas. Oper Neurosurg (Hagerstown) 2023; 24:121-130. [PMID: 36637296 DOI: 10.1227/ons.0000000000000464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 08/10/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND There is controversy over the choice of optimal approach for olfactory groove meningiomas (OGM). The endoscopic endonasal approach (EEA) is one of the most recently described corridors, which provides direct access to the tumor base. OBJECTIVE To detail the evolution of the endoscopic endonasal technique over the past 2 decades and demonstrate the impact of this evolution on patient outcomes. METHODS This is a retrospective study based on a prospectively maintained database of consecutive cases of OGM operated on at our institution via EEA. For analysis, the whole cohort has been divided into 3 equal "eras" according to the time period during which the surgery happened, creating early, middle, and contemporary groups. RESULTS Seventy-five patients were included, 25 in each group. The rate of postoperative cerebrospinal fluid leak significantly decreased over time (28%, 32%, and 8% in the early, middle, and contemporary groups, respectively, P = .020). The rate of postoperative encephalomalacia was significantly lower in more recent groups (24%, 16%, and 0% in the early, middle, and contemporary groups, respectively, P = .029), as was the time to resolution of postoperative brain edema (103.9 months, 87.3 months, and 16.8 months in the early, middle, and contemporary groups, respectively, P = .020). CONCLUSION The endoscopic endonasal approach for OGM significantly evolved over time, achieving lower cerebrospinal fluid leak rates while providing a high rate of Simpson grade 1 resection. Technical improvements minimized the frontal lobe impact. Current data support EEA as a safe and effective corridor to treat OGM.
Collapse
Affiliation(s)
- Pierre-Olivier Champagne
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Georgios A Zenonos
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Eric W Wang
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Carl H Snyderman
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Paul A Gardner
- Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
3
|
Roa Montes de Oca JC, Gonçalves Estella JM, Nieto-Librero AB, Galindo-Villardón P, Roa Ramírez CJ, Gonçalves Sánchez J, Berhouma M, Cornelius JF, Daniel RT, Zazpe I, Froelich S, Jouanneau E, Mazzatenta D, Messerer M, Meling T, Paraskevopoulos D, Roche PH, Schroeder HWS, Tatagiba M, Visocchi M, Voormolen E, Ekkehard K, Bruneau M. Olfactory Groove Meningiomas: Comprehensive assessment between the different microsurgical transcranial approaches and the Endoscopic Endonasal Approaches, systematic review and metanalysis on behalf of the EANS skull base section. BRAIN & SPINE 2022; 2:101661. [PMID: 36605386 PMCID: PMC9808463 DOI: 10.1016/j.bas.2022.101661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 09/23/2022] [Accepted: 10/15/2022] [Indexed: 11/06/2022]
Abstract
•OGM surgery is much more complex than a simple debate of "from above or from below" (transcranial vs endoscopic).•Lateral Sub-frontal and Superior Interhemispheric seem the most effective, superior and versatile approaches for OGM.•Minimally Invasive Transcranial approaches showed no inferiority in OGM sized <4 cm.•Endoscopic Endonasal Approaches showed inferior results in surgical and in functional outcomes for OGM.
Collapse
Affiliation(s)
- Juan Carlos Roa Montes de Oca
- Department of Neurosurgery, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain,Department of Surgery - Neurosurgery, Universidad de Salamanca. Facultad de Medicina, Salamanca, Spain,Policlínica San Javier, Telemedicine Neurosurgery Consultant, Barquisimeto, Venezuela,Centro de Enseñanza e Investigación del Ultrasonido en Medicina (CEIUM), Barquisimeto, Venezuela
| | - Jesús María Gonçalves Estella
- Department of Neurosurgery, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain,Department of Surgery - Neurosurgery, Universidad de Salamanca. Facultad de Medicina, Salamanca, Spain,Corresponding author. University of Salamanca, Faculty of Medicine, Department of Surgery, Neurosurgery, Campus Miguel de Unamuno, C/ Alfonso X El Sabio s/n, 37007, Salamanca, Spain.
| | | | - Purificación Galindo-Villardón
- Department of Statistics, Universidad de Salamanca, Salamanca, Spain,Centro de Investigación Institucional (CII). Universidad Bernardo O’Higgins, Av. Viel 1497, Santiago, Chile
| | - Carlos Julio Roa Ramírez
- Department of Neuroradiology. Policlinica San Javier, Barquisimeto, Venezuela,Centro de Enseñanza e Investigación del Ultrasonido en Medicina (CEIUM), Barquisimeto, Venezuela,Centro Docente de Imágenes de Alta Tecnología (CEDIAT), Barquisimeto, Venezuela
| | | | - Moncef Berhouma
- Department of Neurosurgery, Hopital Neurologique Pierre Wertheimer, Hospices Civils de Lyon, France
| | | | - Roy Thomas Daniel
- Department of Neurosurgery, Department of Neuroscience, Centre Hospitalier Universitaire Vaudois, University Hospital Lausanne, Switzerland
| | - Idoya Zazpe
- Department of Neurosurgery, University Hospital of Navarre, Pamplona, Spain
| | - Sébastien Froelich
- Department of Neurosurgery, Lariboisière Hospital, Université Paris Diderot, Paris, France
| | - Emmanuel Jouanneau
- Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, Lyon, France
| | - Diego Mazzatenta
- Department of Neurosurgery, Neurological Sciences Institut IRCCS, Bologna, Italy
| | - Mahmoud Messerer
- Department of Neurosurgery, Department of Neuroscience, Centre Hospitalier Universitaire Vaudois, University Hospital Lausanne, Switzerland
| | - Torstein Meling
- Department of Neurosurgery, University Hospital of Geneva, Geneva, Switzerland
| | - Dimitrios Paraskevopoulos
- Department of Neurosurgery, Barts Health NHS Trust, St. Bartolomew’s and the Royal London Hospital, Barts and the London School of Medicine and Dentistry, QMUL, London, UK
| | - Pierre-Hugues Roche
- Department of Neurosurgery, Aix-Marseille Université, Assistance Publique-Hôpitaux de Marseille, Hôpital Nord, Marseille, France
| | | | - Marcos Tatagiba
- Department of Neurosurgery, University Hospital Tübingen, Tübingen, Germany
| | - Massimilliano Visocchi
- Department of Neurosurgery, Institute of Neurosurgery Catholic University of Rome, Italy
| | - Eduard Voormolen
- Department of Neurosurgery, University Medical Center Utrecht, Netherlands
| | - Kasper Ekkehard
- Department of Neurosurgery, Steward Medical Group, Brighton, USA
| | - Michaël Bruneau
- Department of Neurosurgery, Universitair Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB), Brussels, Belgium
| |
Collapse
|
4
|
Midline Skull Base Meningiomas: Transcranial and Endonasal Perspectives. Cancers (Basel) 2022; 14:cancers14122878. [PMID: 35740543 PMCID: PMC9220797 DOI: 10.3390/cancers14122878] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/25/2022] [Accepted: 06/03/2022] [Indexed: 12/07/2022] Open
Abstract
Simple Summary Skull base meningiomas have always represented a challenge for neurosurgeons. Despite their histological nature, they may be associated with unfavorable outcomes due to their deep-seated location and the surrounding neurovascular structures. Over time, several corridors have been proposed, each one carrying its own pros and cons. During the last decades, the endoscopic endonasal route has been asserted among the classic routes for a growing number of midline and paramedian lesions. Therefore, the aim of our paper is to present a comprehensive review of the indications and techniques for the management of skull base meningiomas, emphasizing the ambivalent and complementary role of the low and high routes. Abstract Skull base meningiomas have always represented a challenge for neurosurgeons. Despite their histological nature, they may be associated with unfavorable outcomes due to their deep-seated location and the surrounding neurovascular structures. The state of the art of skull base meningiomas accounts for both transcranial, or high, and endonasal, or low, routes. A comprehensive review of the pertinent literature was performed to address the surgical strategies and outcomes of skull base meningioma patients treated through a transcranial approach, an endoscopic endonasal approach (EEA), or both. Three databases (PubMed, Ovid Medline, and Ovid Embase) have been searched. The review of the literature provided 328 papers reporting the surgical, oncological, and clinical results of different approaches for the treatment of skull base meningiomas. The most suitable surgical corridors for olfactory groove, tuberculum sellae, clival and petroclival and cavernous sinus meningiomas have been analyzed. The EEA was proven to be associated with a lower extent of resection rates and better clinical outcomes compared with transcranial corridors, offering the possibility of achieving the so-called maximal safe resection.
Collapse
|
5
|
Marquardt G, Quick-Weller J, Tritt S, Baumgarten P, Senft C, Seifert V. Two-step staged resection of giant olfactory groove meningiomas. Acta Neurochir (Wien) 2021; 163:3425-3431. [PMID: 34373942 PMCID: PMC8599346 DOI: 10.1007/s00701-021-04910-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 06/10/2021] [Indexed: 12/05/2022]
Abstract
Background The surgical treatment of giant olfactory groove meningiomas (OGMs) with marked perilesional brain oedema is still a surgical challenge. After tumour resection, increase of brain oedema may occur causing dramatic neurological deterioration and even death of the patient. The objective of this paper is to describe surgical features of a two-step staged resection of these tumours performed to counter increase of postoperative brain oedema. Methods This two-step staged resection procedure was carried out in a consecutive series of 19 patients harbouring giant OGMs. As first step, a bifrontal craniectomy was performed followed by a right-sided interhemispherical approach. About 80% of the tumour mass was resected leaving behind a shell-shaped tumour remnant. In the second step, carried out after the patients’ recovery from the first surgery and decline of oedema, the remaining part of the tumour was removed completely followed by duro- and cranioplasty. Results Ten patients recovered quickly from first surgery and the second operation was performed after a mean of 12.4 days. In eight patients, the second operation was carried out later between day 25 and 68 due to surgery-related complications, development of a trigeminal zoster, or to a persisting frontal brain oedema. Mean follow-up was 49.3 months and all but one patient had a good outcome regardless of surgery-related complications. Conclusions Our results suggest that a two-step staged resection of giant OGMs minimizes the increase of postoperative brain oedema as far as possible and translates into lower morbidity and mortality.
Collapse
Affiliation(s)
- Gerhard Marquardt
- Department of Neurosurgery, Goethe - University, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany.
| | - Johanna Quick-Weller
- Department of Neurosurgery, Goethe - University, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
| | - Stephanie Tritt
- Department of Neuroradiology, Goethe - University, Frankfurt am Main, Germany
| | - Peter Baumgarten
- Department of Neurosurgery, Goethe - University, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
| | - Christian Senft
- Department of Neurosurgery, Goethe - University, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
| | - Volker Seifert
- Department of Neurosurgery, Goethe - University, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany
| |
Collapse
|
6
|
Feng AY, Wong S, Saluja S, Jin MC, Thai A, Pendharkar AV, Ho AL, Reddy P, Efron AD. Resection of Olfactory Groove Meningiomas Through Unilateral vs. Bilateral Approaches: A Systematic Review and Meta-Analysis. Front Oncol 2020; 10:560706. [PMID: 33194626 PMCID: PMC7642686 DOI: 10.3389/fonc.2020.560706] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 08/31/2020] [Indexed: 12/29/2022] Open
Abstract
Introduction: Consensus is limited regarding optimal transcranial approaches (TCAs) for the surgical resection of olfactory groove meningiomas (OGMs). This systematic review and meta-analysis aims to examine operative and peri-operative outcomes of unilateral compared to bilateral TCAs for OGMs. Methods: Electronic databases were searched from inception until December 2019 for studies delineating TCAs for OGM patients. Patient demographics, pre-operative symptoms, surgical outcomes, and complications were evaluated and analyzed with a meta-analysis of proportions. Results: A total of 27 observational case series comparing 554 unilateral vs. 451 bilateral TCA patients were eligible for review. The weighted pooled incidence of gross total resection is 94.6% (95% CI, 90.7-97.5%; I 2 = 59.0%; p = 0.001) for unilateral and 90.9% (95% CI, 85.6-95.4%; I 2 = 58.1%; p = 0.003) for bilateral cohorts. Similarly, the incidence of OGM recurrence is 2.6% (95% CI, 0.4-6.0%; I 2 = 53.1%; p = 0.012) and 4.7% (95% CI, 1.4-9.2%; I 2 = 55.3%; p = 0.006), respectively. Differences in oncologic outcomes were not found to be statistically significant (p = 0.21 and 0.35, respectively). Statistically significant differences in complication rates in bilateral vs. unilateral TCA cohorts include meningitis (1.0 vs. 0.0%; p = 0.022) and mortality (3.2 vs. 0.2%; p = 0.007). Conclusions: While both cohorts have similar oncologic outcomes, bilateral TCA patients exhibit higher post-operative complication rates. This may be explained by underlying tumor characteristics necessitating more radical resection but may also indicate increased morbidity with bilateral approaches. However, evidence from more controlled, comparative studies is warranted to further support these findings.
Collapse
Affiliation(s)
- Austin Y Feng
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Sandy Wong
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Sabir Saluja
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Michael C Jin
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Anthony Thai
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Arjun V Pendharkar
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Allen L Ho
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Prasad Reddy
- Department of Neurosurgery, Kaiser Permanente, Redwood City, CA, United States
| | - Allen D Efron
- Department of Neurosurgery, Kaiser Permanente, Redwood City, CA, United States
| |
Collapse
|
7
|
Adib SD, Herlan S, Ebner FH, Hirt B, Tatagiba M, Honegger J. Interoptic, Trans-lamina Terminalis, Opticocarotid Triangle, and Caroticosylvian Windows From Mini-Supraorbital, Frontomedial, and Pterional Perspectives: A Comparative Cadaver Study With Artificial Lesions. Front Surg 2019; 6:40. [PMID: 31380387 PMCID: PMC6646665 DOI: 10.3389/fsurg.2019.00040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 06/17/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction: The mini-supraorbital (MSO) and pterional (PT) approaches have been compared in a number of studies focusing on the treatment of aneurysms, craniopharyngiomas, and meningiomas. The goal of this study was to analyze the surgical exposure to different artificial lesions through interoptic (IO), trans-lamina terminalis (TLT), opticocarotid triangle (OCT), and caroticosylvian (CS) windows from the MSO, frontomedial (FM), and PT perspectives. Methods: The MSO, PT, and FM approaches were performed sequentially in two fixed cadaver heads. Three colored spheres were placed around the optic chiasm: (1) between the optic nerves; (2) between the optic nerve and the internal carotid artery; and (3) between the internal carotid artery and the oculomotor nerve. The surgical exposures to these structures by using the IO, TLT, OCT, and CS windows were compared. Results: (1) IO window: from the MSO and PT approaches, the total surgical exposure mainly allows visualization of contralateral lesions. The FM approach was superior for exploration of both sides of the area between the optic nerves. (2) TLT pathway: the MSO and PT approaches mainly expose the contralateral third ventricle wall. (3) OCT window: the PT approach allows exposure of a larger part of the sphere between the optic nerve and the internal carotid artery than the MSO approach. (4) CS window: the PT approach allows a better exposure of lateral structures such as the oculomotor nerve and of the medial prepontine area in comparison to the MSO approach. Conclusion: Simulation of the surgical situation with artificial lesions is a good model for comparing surgical perspectives and for analyzing feasibility of lesion exposure and resection.
Collapse
Affiliation(s)
- Sasan Darius Adib
- Department of Neurosurgery, University of Tübingen, Tübingen, Germany
| | - Stephan Herlan
- Department of Clinical Anatomy and Cell Analysis, University of Tübingen, Tübingen, Germany
| | - Florian H Ebner
- Department of Neurosurgery, University of Tübingen, Tübingen, Germany
| | - Bernhard Hirt
- Department of Clinical Anatomy and Cell Analysis, University of Tübingen, Tübingen, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery, University of Tübingen, Tübingen, Germany
| | - Juergen Honegger
- Department of Neurosurgery, University of Tübingen, Tübingen, Germany
| |
Collapse
|
8
|
Vincent A, Wang W, Sokoya M, Kadakia S, Chan D, Ducic Y. Orbitocranial Approaches to the Skull Base. Semin Plast Surg 2019; 33:114-119. [PMID: 31037048 DOI: 10.1055/s-0039-1685478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
There are a myriad of approaches and surgical options for removal and treatment of skull base diseases. While, historically, large open approaches have been preferred, several endoscopic and minimally invasive techniques are now available that preserve intraoperative visualization and surgical success while minimizing morbidity and recovery times. Herein, the authors review common open, minimally invasive, and endoscopic approaches to the anterior skull base.
Collapse
Affiliation(s)
- Aurora Vincent
- Otolaryngology, Head and Neck Surgery, Madigan Army Medical Center, Tacoma, Washington
| | - Weitao Wang
- Department of Otolaryngology, University of Rochester, Rochester, New York
| | | | - Sameep Kadakia
- Department of Plastic and Reconstructive Surgery, Wright State University, Dayton, Ohio
| | - David Chan
- Otolaryngology, Head and Neck Surgery, University of Chicago, Illinois
| | - Yadranko Ducic
- Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
| |
Collapse
|
9
|
Transfrontal-Sinus-Subcranial Approach to Olfactory Groove Meningiomas: Surgical Results and Clinical and Functional Outcome in a Consecutive Series of 21 Patients. World Neurosurg 2017; 101:315-324. [PMID: 28213192 DOI: 10.1016/j.wneu.2017.02.039] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 02/06/2017] [Accepted: 02/07/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND The transfrontal-sinus-subcranial approach (TFSSA) allows for direct exposure and removal of olfactory groove meningiomas (OGMs), without any brain retraction. Compared with other skull base approaches (e.g., fronto-orbitobasal, transbasal, subcranial, fronto-orbitozygomatic, and one-and-half approach), it could offer the same advantages but is less invasive. OBJECTIVE We report the results in a series of 21 consecutive patients with OGMs and operated on through TFSSA, to propose a viable alternative approach. METHODS Mean maximum tumor diameter was 45.9 ± 3.4 mm (range, 25-70 mm). The aim of surgery was Simpson grade I removal. Surgical, clinical, and functional outcomes were reported. Mean follow-up was 87 ± 7 months (range, 36-176 months). RESULTS In all patients, magnetic resonance imaging 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 < 0.001) and smell sense was preserved only in patients with 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 < 0.001) and no patients worsened their cognitive profile. Visual function improved in 7/8 (87.5%). Karnofsky Performance Scale score after surgery significantly increased (P < 0.001). 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.
Collapse
|
10
|
Olfactory Groove Meningiomas: Comparison of Extent of Frontal Lobe Changes After Lateral and Bifrontal Approaches. World Neurosurg 2016; 94:211-221. [PMID: 27373938 DOI: 10.1016/j.wneu.2016.06.101] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2016] [Revised: 06/21/2016] [Accepted: 06/22/2016] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Olfactory groove meningiomas often are behaviorally silent. Numerous surgical approaches have been described in the literature for the successful removal of these meningiomas. Lateral (pterional/frontolateral) and anterior (bifrontal/fronto-orbito-basal) approaches with their various modifications remain the 2 major corridors in resecting them. In this study, we discuss our experience in microsurgical treatment of these tumors at our institution and assess the extent of frontal lobe damage after the resection of tumor. METHODS We reviewed the medical records of patients who underwent surgical excision of olfactory groove meningiomas from 1990 to 2014. To measure the extent of frontal lobe damage via lateral and anterior approaches, we measured the volume of porencephalic cave in the postoperative magnetic resonance imaging by using Brainlab software. The ratio of volume of porencephalic cave to tumor was measured between 2 sides and 2 approaches. RESULTS Fifty-seven patients with olfactory groove meningiomas, who underwent 62 microsurgical resection procedures in 1990-2014 were included in the study (74% were more than 5 cm at presentation). Pterional and bifrontal craniotomies were the most commonly used approaches. At follow-up, the volume of porencephalic cave after lateral approach was significantly less in the side contralateral to craniotomy irrespective of tumor size. The difference between ratio of volume of porencephalic cave and initial tumor was significantly less after lateral approaches, when compared to anterior approaches. CONCLUSIONS Lateral approaches (pterional/frontolateral) resulted in less frontal lobe change and better olfactory preservation in comparison to anterior approaches in present series.
Collapse
|
11
|
Frontobasal Midline Meningiomas: Is It Right To Shed Doubt on the Transcranial Approaches? Updates and Review of the Literature. World Neurosurg 2015; 88:374-382. [PMID: 26555506 DOI: 10.1016/j.wneu.2015.11.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 11/01/2015] [Accepted: 11/02/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Traditionally, the surgical removal of tuberculum sellae meningioma (TSM) and olfactory groove meningioma (OGM) requires transcranial approaches and microsurgical techniques, but in the last decade endoscopic expanded endonasal approaches have been introduced: transcribriform for OGMs and transtuberculum-transplanum for TSM. A comparative analysis of the literature concerning the two types of surgical treatment of OGMs and TSM is, however, difficult. METHODS We conducted a literature search using the PubMed database to compare data for endoscopic and microsurgical techniques in the literature. We also conducted a retrospective analysis of selected cases from our series presenting favorable characteristics for an endoscopic approach, based on the criteria of operability of these lesions as generally accepted in the literature, and we compared the results obtained in these patients with those in the endoscopic literature. RESULTS We believe that making the sample more homogeneous, the difference between microsurgical technique and endoscopic technique is no longer so striking. A greater radical removal rate, a reduced incidence of cerebrospinal fluid fistula and, especially, the possibility of removing lesions of any size are advantages of transcranial surgery; a higher percentage of improvement in visual outcome and a lower risk of a worsening of a pre-existing deficit or onset of a new deficit are advantages of the endoscopic technique. CONCLUSION At present, the microsurgical technique is still the gold standard for the removal of the anterior cranial fossa meningiomas of all sizes, and the endoscopic technique remains a second option in certain cases.
Collapse
|
12
|
Prevedello DM, Ditzel Filho LFS, Fernandez-Miranda JC, Solari D, do Espírito Santo MP, Wehr AM, Carrau RL, Kassam AB. Magnetic resonance imaging fluid-attenuated inversion recovery sequence signal reduction after endoscopic endonasal transcribiform total resection of olfactory groove meningiomas. Surg Neurol Int 2015; 6:158. [PMID: 26539309 PMCID: PMC4604640 DOI: 10.4103/2152-7806.166846] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 05/13/2015] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Olfactory groove meningiomas grow insidiously and compress adjacent cerebral structures. Achieving complete removal without further damage to frontal lobes can be difficult. Microsurgical removal of large lesions is a challenging procedure and usually involves some brain retraction. The endoscopic endonasal approaches (EEAs) for tumors arising from the anterior fossa have been well described; however, their effect on the adjacent brain tissue has not. Herein, the authors utilized the magnetic resonance imaging fluid attenuated inversion recovery (FLAIR) sequence signal as a marker for edema and gliosis on pre- and post-operative images of olfactory groove meningiomas, thus presenting an objective parameter for brain injury after surgical manipulation. METHODS Imaging of 18 olfactory groove meningiomas removed through EEAs was reviewed. Tumor and pre/postoperative FLAIR signal volumes were assessed utilizing the DICOM image viewer OsiriX(®). Inclusion criteria were: (1) No previous treatment; (2) EEA gross total removal; (3) no further treatment. RESULTS There were 14 females and 4 males; the average age was 53.8 years (±8.85 years). Average tumor volume was 24.75 cm(3) (±23.26 cm(3), range 2.8-75.7 cm(3)), average preoperative FLAIR volume 31.17 cm(3) (±39.38 cm(3), range 0-127.5 cm(3)) and average postoperative change volume, 4.16 cm(3) (±6.18 cm(3), range 0-22.2 cm(3)). Average time of postoperative scanning was 6 months (range 0.14-20 months). In all cases (100%) gross total tumor removal was achieved. Nine patients (50%) had no postoperative FLAIR changes. In 2 patients (9%) there was minimal increase of changes postoperatively (2.2 cm(3) and 6 cm(3) respectively); all others demonstrated image improvement. The most common complication was postoperative cerebrospinal fluid leakage (27.8%); 1 patient (5.5%) died due to systemic complications and pulmonary sepsis. CONCLUSIONS FLAIR signal changes tend to resolve after endonasal tumor resection and do not seem to worsen with this operative technique.
Collapse
Affiliation(s)
- Daniel M. Prevedello
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Leo F. S. Ditzel Filho
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Juan C. Fernandez-Miranda
- Department of Neurological Surgery, University of Pittsburgh Medical Center, UPMC Presbyterian, Pittsburgh, PA 15213, USA
| | - Domenico Solari
- Department of Neurological Sciences, Division of Neurosurgery, University of Napoli Federico II, 80131 Naples, Italy
| | - Marcelo Prudente do Espírito Santo
- Department of Neurological Surgery, University of São Paulo, Central Institute of the University of São Paulo Medical School Clinical Hospital, São Paulo, Brazil
| | - Allison M. Wehr
- Department of Biomedical Informatics, Center for Biostatistics, College of Medicine, The Ohio State University, Columbus, OH 43221, USA
| | - Ricardo L. Carrau
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
- Department of Otolaryngology - Head and Neck Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA
| | - Amin B. Kassam
- Department of Neurosurgery, Aurora Neuroscience Innovation Institute, Milwaukee, WI 53215, USA
| |
Collapse
|
13
|
Czyz M, Tabakow P, Hernandez-Sanchez I, Jarmundowicz W, Raisman G. Obtaining the olfactory bulb as a source of olfactory ensheathing cells with the use of minimally invasive neuroendoscopy-assisted supraorbital keyhole approach—cadaveric feasibility study. Br J Neurosurg 2015; 29:362-70. [DOI: 10.3109/02688697.2015.1006170] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
14
|
Perioperative microdialysis in meningioma surgery: correlation of cerebral metabolites with clinical outcome. Acta Neurochir (Wien) 2014; 156:2275-82; discussion 2282. [PMID: 25305088 DOI: 10.1007/s00701-014-2242-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Accepted: 09/15/2014] [Indexed: 02/06/2023]
Abstract
BACKGROUND Brain tumour resection requires surgical manoeuvres that may cause an ischaemic injury to peritumoral tissue. The aim of the present study was to examine whether putative alterations in peritumoral tissue biochemistry, monitored by microdialysis, correlate with clinical outcome in patients undergoing craniotomy for meningioma resection. METHODS In 34 patients undergoing meningioma resection (35 % male; mean age ± SD: 54.3 ± 12.1 years), microdialysis measurements were taken perioperatively from peritumoral brain parenchyma. Standard metabolites (glucose, lactate, pyruvate, glycerol and the lactate:pyruvate ratio) were quantified in relation to clinical outcome assessed by the Glasgow Coma Scale (GCS) and the Karnofsky Performance Status scale. RESULTS Higher postoperative glucose and pyruvate levels were found in patients with a favourable outcome (GCS not deteriorated or Karnofsky score > 80). Multiple logistic regression analysis (age, preoperative physical status, metabolite levels as independent variables) showed that lower postoperative glucose and pyruvate levels as well as higher lactate:pyruvate ratio values were independently associated with an unfavourable outcome as defined by Karnofsky score <80 [(OR: 0.084, 95 % CI: 0.01-0.98, p = 0.049), (OR: 0.97, 95 % CI: 0.95-0.99, p = 0.050), (OR: 1.21, 95 % CI: 1.04-1.42, p = 0.015) respectively], as well as with death [(OR: 0.08, 95 % CI: 0.01-0.97, p = 0.046), (OR: 0.94, 95 % CI: 0.89-0.99, p = 0.016), (OR: 1.07, 95 % CI: 1.00-1.15, p = 0.05) respectively]. CONCLUSIONS Postoperative levels of glucose and pyruvate and the lactate:pyruvate ratio appear to correlate with clinical outcome in patients undergoing meningioma resection. The present findings provide support for the utility of microdialysis as a prognostic tool in brain tumour surgery.
Collapse
|
15
|
Zygourakis CC, Sughrue ME, Benet A, Parsa AT, Berger MS, McDermott MW. Management of Planum/Olfactory Meningiomas: Predicting Symptoms and Postoperative Complications. World Neurosurg 2014; 82:1216-23. [DOI: 10.1016/j.wneu.2014.08.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2013] [Revised: 03/24/2014] [Accepted: 08/06/2014] [Indexed: 11/28/2022]
|
16
|
The anterior interhemispheric approach: a safe and effective approach to anterior skull base lesions. Acta Neurochir (Wien) 2014; 156:689-96. [PMID: 24402551 DOI: 10.1007/s00701-013-1972-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 12/04/2013] [Indexed: 10/25/2022]
Abstract
BACKGROUND Many approaches to the anterior skull base have been reported. Frequently used are the pterional, the unilateral or bilateral frontobasal, the supraorbital and the frontolateral approach. Recently, endoscopic transnasal approaches have become more popular. The benefits of each approach has to be weighted against its complications and limitations. The aim of this study was to investigate if the anterior interhemispheric approach (AIA) could be a safe and effective alternative approach to tumorous and non-tumorous lesions of the anterior skull base. METHODS We screened the operative records of all patients with an anterior skull base lesion undergoing transcranial surgery. We have used the AIA in 61 patients. These were exclusively patients with either olfactory groove meningioma (OGM) (n = 43), ethmoidal dural arteriovenous fistula (dAVF) ( n = 6) or frontobasal fractures of the anterior midline with cerebrospinal fluid (CSF) leakage ( n = 12). Patient records were evaluated concerning accessibility of the lesion, realization of surgical aims (complete tumor removal, dAVF obliteration, closure of the dural tear), and approach related complications. RESULTS The use of the AIA exclusively in OGMs, ethmoidal dAVFs and midline frontobasal fractures indicated that we considered lateralized frontobasal lesions not suitable to be treated successfully. If restricted to these three pathologies, the AIA is highly effective and safe. The surgical aim (complete tumor removal, complete dAVF occlusion, no rhinorrhea) was achieved in all patients. The complication rate was 11.5 % (wound infection (n = 2; 3.2 %), contusion of the genu of the corpus callosum, subdural hygroma, epileptic seizure, anosmia and asymptomatic bleed into the tumor cavity (n = 1 each). Only the contusion of the corpus callosum was directly related to the approach (1.6 %). Olfaction, if present before surgery, was preserved in all patients, except one (1.6 %). CONCLUSIONS The AIA is an effective and a safe approach to tumorous, vascular and traumatic pathologies of the midline anterior skull base. This approach should be part of the armamentarium of skull base surgeons.
Collapse
|
17
|
Czyż M, Tabakow P, Gheek D, Miś M, Jarmundowicz W, Raisman G. The supraorbital keyhole approach via an eyebrow incision applied to obtain the olfactory bulb as a source of olfactory ensheathing cells – radiological feasibility study. Br J Neurosurg 2013; 28:234-40. [DOI: 10.3109/02688697.2013.817534] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
18
|
Bitter AD, Stavrinou LC, Ntoulias G, Petridis AK, Dukagjin M, Scholz M, Hassler W. The Role of the Pterional Approach in the Surgical Treatment of Olfactory Groove Meningiomas: A 20-year Experience. J Neurol Surg B Skull Base 2013; 74:97-102. [PMID: 24436895 DOI: 10.1055/s-0033-1333618] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 10/19/2012] [Indexed: 10/27/2022] Open
Abstract
Background Olfactory groove meningiomas remain surgically challenging. The common microsurgical approaches suffer from late exposure of the neurovascular structures. Conversely, the pterional approach has the advantage of early dissection of the posterior neurovascular complex. Methods We reviewed the records of patients treated for olfactory groove meningioma in our department between 1991 and 2010. A total of 61 patients underwent removal of olfactory groove meningiomas via the pterional approach. These included 58 primary and 3 recurrent tumors. Mean overall follow-up time was 122 months. Results Early exposure and dissection of the internal carotid artery, middle cerebral artery, anterior cerebral artery, and optic nerve was feasible in all cases. Complete tumor removal was achieved in 60 patients. Morbidity and mortality rates were 26% and 1.6% respectively. Postoperative complications included epileptic seizures (five patients) and cerebrospinal fluid (CSF) leak (two patients). During follow-up, we recorded three tumor recurrences. Conclusions The pterional approach appears to be an excellent solution for the treatment of olfactory groove meningiomas. Its foremost advantage is early visualization of the posterior neurovascular complex. Moreover, it allows frontal sinus preservation and timely tumor devascularization and avoids excessive brain retraction. The pterional view is familiar to most neurosurgeons and therefore the transition to this technique is fairly straightforward.
Collapse
Affiliation(s)
- Andrej D Bitter
- Department of Neurosurgery, Klinikum Duisburg, Duisburg NRW, Germany
| | - Lampis C Stavrinou
- Department of Neurosurgery, Evangelisches Krankenhaus Bielefeld, Bielefeld NRW, Germany
| | - Georgios Ntoulias
- Department of Neurosurgery, Klinikum Duisburg, Duisburg NRW, Germany
| | | | - Morina Dukagjin
- Department of Neurosurgery, Klinikum Duisburg, Duisburg NRW, Germany
| | - Martin Scholz
- Department of Neurosurgery, Klinikum Duisburg, Duisburg NRW, Germany
| | - Werner Hassler
- Department of Neurosurgery, Klinikum Duisburg, Duisburg NRW, Germany
| |
Collapse
|
19
|
Murai Y, Mizunari T, Kobayashi S, Teramoto A. Surgical technique for the prevention of cerebrospinal fluid leakage after bifrontal craniotomy. World Neurosurg 2013; 81:344-7. [PMID: 23314023 DOI: 10.1016/j.wneu.2013.01.032] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2012] [Revised: 08/10/2012] [Accepted: 01/08/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Cerebrospinal fluid leakage and meningitis caused by frontal sinus (FS) exposure are characteristic complications of bifrontal craniotomy used for treating skull base tumors and anterior communicating artery aneurysms. Prevention of these complications is of utmost importance. We describe in detail our procedure for sealing exposed FSs during bifrontal craniotomy and present the results and outcomes of the procedure. METHODS A total of 51 consecutive patients who had undergone bifrontal craniotomy for tuberculum sellae meningiomas, craniopharyngiomas, anterior cerebral artery aneurysms, or other frontal skull base lesions at our institute were selected for the study. Our technique for sealing exposed FSs is described below. The mucosa was sterilized using surgical cotton dipped in iodine. After craniotomy, the exposed mucosa was sealed using 7-0 nylon sutures, whereas Gelfoam with fibrin glue was used to ensure watertight closure. The exposed portions of the FSs were covered by bone covers made of internal table bone and sealed. As a final layer, frontal periosteal flaps were sutured to the frontal base dura mater. RESULTS Postoperative cerebrospinal fluid leakage or meningitis did not occur in any of our patients. CONCLUSION Our results indicate the effectiveness of our technique in the prevention of FS-related postoperative complications.
Collapse
Affiliation(s)
- Yasuo Murai
- Department of Neurosurgery, Nippon Medical School, Tokyo, Japan.
| | | | - Shiro Kobayashi
- Department of Neurosurgery, Nippon Medical School, Tokyo, Japan
| | - Akira Teramoto
- Department of Neurosurgery, Nippon Medical School, Tokyo, Japan
| |
Collapse
|
20
|
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.
Collapse
Affiliation(s)
- Sophie Curey
- Department of Neurosurgery, Rouen University Hospital, Rouen, France
| | | | | | | | | | | | | | | |
Collapse
|
21
|
Abstract
Olfactory groove meningiomas can present as large and insidious masses in the anterior cranial base. Due to their location and minimal clinical symptoms, these tumors can go undetected until they have grown extremely large. We present a clinical case and discuss the surgical management of a 63-year-old man who presented for an initial eye examination with bilateral visual loss for over 2 years due to a giant olfactory meningioma encompassing his entire frontal lobe and compressing on his optic nerves.
Collapse
Affiliation(s)
- Jesse J Jung
- Department of Ophthalmology, New York University School of Medicine, New York, NY, USA
| | | | | |
Collapse
|
22
|
Komotar RJ, Starke RM, Raper DMS, Anand VK, Schwartz TH. Endoscopic skull base surgery: a comprehensive comparison with open transcranial approaches. Br J Neurosurg 2012; 26:637-48. [PMID: 22324437 DOI: 10.3109/02688697.2012.654837] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Little data exists comparing endoscopic endonasal approaches to pathology of the anterior skull base with more traditional transcranial and transsphenoidal microscopic approaches. In order to more fully characterize the role of endoscopy in the management of pathology of the anterior cranial base, we conducted a systematic review of case series and case reports documenting surgical and clinical outcomes. We found that for craniopharyngiomas, clival chordomas, esthesioneuroblastomas and giant pituitary adenomas, the endonasal endoscopic approach can result in equivalent or higher rates of gross total resection than open approaches. For meningiomas, however, open transcranial approaches are still able to achieve higher rates of total resection. CSF leak rates are higher for patients undergoing endoscopic surgery for meningiomas and craniopharyngiomas, but not for chordomas, esthesioneuroblastomas or giant pituitary adenomas. In certain patients, the endonasal endoscopic approach may be a safe and effective alternative for the treatment of a wide variety of skull base pathology, particularly those with small midline tumours.
Collapse
Affiliation(s)
- Ricardo J Komotar
- Department of Neurological Surgery, University of Miami, Miami, FL, USA
| | | | | | | | | |
Collapse
|
23
|
Giant olfactory groove meningiomas: extent of frontal lobes damage and long-term outcome after the pterional approach. World Neurosurg 2011; 76:311-7; discussion 255-8. [PMID: 21986430 DOI: 10.1016/j.wneu.2011.03.021] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2010] [Revised: 01/09/2011] [Accepted: 03/19/2011] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The treatment of giant olfactory groove meningiomas (OGMs; maximum diameter ≥ 6 cm) poses special problems and represents a surgical challenge. We discuss the long-term results in a series of 18 patients with giant OGMs and report our experience on a global strategy encompassing the pterional approach to manage the lesion and an extended transbasal approach to treat recurrences. METHODS Between February 1991 and December 2007, 18 patients with giant OGMs were surgically managed via a pterional craniotomy. Postoperative follow-up imaging was obtained at one, six, and 12 months and then yearly. In preoperative images, data from tumor volume were assessed. The volume of the residual right frontal porencephalic cave (ipsilateral to the operative side) was compared with the volume of the porencephalic cave measured in the left frontal lobe (internal control) in each case. Comparison between porencephalic cave and the original tumor volume for each side was also performed. RESULTS At the first operation in 17 of 18 patients (94.4%), the tumor resection was accomplished by a complete macroscopic lesion removal and coagulation of its dural attachment (Simpson grade II). In one patient, a Simpson grade V resection was obtained. The mean follow-up was 93.5 months, ranging from 12 to 214 months. Recurrences were observed in three patients (16.7%) at 103, 102, and 128 months, respectively, from the time of the first operation. These patients were operated on via an extended subfrontal transbasal approach accomplishing a complete (Simpson grade I) resection. No death occurred. The visual deficit improved in seven of 13 patients (53.8%), remained stable in five (38.5%), and worsened in one patient (7.7%). Overall, 17 of 18 patients (94.4%) had a good outcome and returned to their previous occupations. All the tumors presented with a symmetrical growth pattern. The mean meningioma volume was 23.51 ± 1.62 cm(3) for the right portion of the tumor and 23.04 ± 1.35 cm(3) for the left portion. The mean residual porencephalic volume was significantly smaller in the left frontal lobe (mean value 5.7 mL) than in the right frontal lobe (mean value 16.6 mL; P < 0.05). The mean residual porencephalic volume was significantly smaller than the tumor volume both in the left (P < 0.01) and in the right side (P < 0.05). CONCLUSION The pterional-transsylvian approach provides two major advantages: first, it minimizes morbidity and mortality through an early neurovascular control and by limiting parenchymal damage as demonstrated by a quantitative analysis; second it is associated with low recurrence rate at a long-term follow-up.
Collapse
|
24
|
Komotar RJ, Starke RM, Raper DMS, Anand VK, Schwartz TH. Endoscopic endonasal versus open transcranial resection of anterior midline skull base meningiomas. World Neurosurg 2011; 77:713-24. [PMID: 22120296 DOI: 10.1016/j.wneu.2011.08.025] [Citation(s) in RCA: 136] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2010] [Revised: 05/26/2011] [Accepted: 08/16/2011] [Indexed: 10/15/2022]
Abstract
OBJECTIVE To assess the advantages and limitations of the endoscopic endonasal approach to anterior skull base meningiomas, a minimally invasive approach that avoids extensive bone drilling, brain retraction, and manipulation of nerves and critical vessels, versus open transcranial surgery. METHODS A MEDLINE (2000-2010) search was performed to identify series for either olfactory groove meningiomas or tuberculum sellae (TS) or planum sphenoidale meningiomas. Statistical analyses of categorical variables such as extent of resection, morbidity, and visual outcome were performed using χ(2) and Fisher exact tests. RESULTS The literature review included 60 studies, involving 1426 patients. Open surgery achieved a higher rate of gross total resection (GTR) for both olfactory groove (P < 0.001) and TS and planum (P < 0.001) meningiomas. Postoperative cerebrospinal fluid (CSF) leak occurred more frequently in the endoscopic cohort (P < 0.001). Other postoperative complications occurred more frequently in the open cohort, although this difference was not statistically significant. There were no significant differences in postoperative visual outcome between the groups. CONCLUSIONS Based on the current literature, open transcranial approaches for olfactory groove and TS and planum sphenoidale meningiomas still result in higher rates of total resection with lower postoperative CSF leak rates. The endoscopic endonasal approach may be safe and effective for certain skull base meningiomas; careful patient selection and multilayer closure techniques are essential.
Collapse
Affiliation(s)
- Ricardo J Komotar
- Department of Neurological Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | | | | | | | | |
Collapse
|
25
|
Pepper JP, Hecht SL, Gebarski SS, Lin EM, Sullivan SE, Marentette LJ. Olfactory groove meningioma: discussion of clinical presentation and surgical outcomes following excision via the subcranial approach. Laryngoscope 2011; 121:2282-9. [PMID: 21994142 DOI: 10.1002/lary.22174] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2011] [Revised: 05/08/2011] [Accepted: 05/10/2011] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS To describe surgical outcomes and radiographic features of olfactory groove meningiomas treated by excision through the subcranial approach. Special emphasis is placed on paranasal sinus and orbit involvement. STUDY DESIGN Retrospective review of a series of patients. METHODS Nineteen patients underwent excision of olfactory groove meningioma (OGM) via the transglabellar/subcranial approach between December 1995 and November 2009. Nine patients had previously undergone prior resection at outside institutions, and four had prior radiotherapy in addition to a prior excision. Transglabellar/subcranial surgical approach to the anterior skull base was performed. RESULTS Tumor histology included three World Health Organization (WHO) grade III lesions, one WHO grade II lesion, and 15 WHO grade I lesions. Fourteen patients had evidence of extension into the paranasal sinuses, with the ethmoid sinus being most commonly involved. Kaplan-Meier estimates of mean overall and disease-free survival were 121.45 months and 93.03 months, respectively. The mean follow-up interval was 41.0 months, and at the time of data analysis three patients had recurrent tumors. Seven (36.8%) patients experienced a major complication in the perioperative period; there were no perioperative mortalities. Orbit invasion was observed in four patients, with optic nerve impingement in 11 patients. Of these, three patients had long-term diplopia. No patients experienced worsening of preoperative visual acuity. CONCLUSIONS Olfactory groove meningiomas demonstrate a propensity to spread into the paranasal sinuses, particularly in recurrent cases. Given a tendency for infiltrative recurrence along the skull base, this disease represents an important area of collaboration between neurosurgery and otolaryngology. The subcranial approach offers excellent surgical access for excision, particularly for recurrences that involve the paranasal sinuses and optic apparatus.
Collapse
Affiliation(s)
- Jon-Paul Pepper
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan Hospital System, Ann Arbor, Michigan, USA
| | | | | | | | | | | |
Collapse
|
26
|
Olfactory groove meningiomas. Neurosurg Rev 2011; 35:195-202; discussion 202. [DOI: 10.1007/s10143-011-0353-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Revised: 04/19/2011] [Accepted: 06/05/2011] [Indexed: 10/17/2022]
|
27
|
|
28
|
Superior interhemispheric approach for midline meningioma from the anterior cranial base. Neurochirurgie 2011; 57:105-13. [DOI: 10.1016/j.neuchi.2011.08.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2011] [Accepted: 07/02/2011] [Indexed: 11/17/2022]
|
29
|
González-Darder J, Bordes-García V, Quilis-Quesada V, Talamantes-Escrivá F, González-López P, Masbout-Kayal G, Pesudo-Martínez J. Meningiomas del surco olfatorio. Tratamiento microquirúrgico radical por vía bifrontal. Neurocirugia (Astur) 2011. [DOI: 10.1016/s1130-1473(11)70011-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
30
|
Rachinger W, Grau S, Tonn JC. Different microsurgical approaches to meningiomas of the anterior cranial base. Acta Neurochir (Wien) 2010; 152:931-9. [PMID: 20383724 DOI: 10.1007/s00701-010-0646-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2010] [Accepted: 03/17/2010] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Meningiomas of the anterior skull base show specific characteristics, which render them difficult to handle. These tumors include olfactory groove, supra- and parasellar, anterior sphenoid ridge, cavernous sinus, and spheno-orbital meningiomas. Tumor localization and size, encasement of important structures as well as the extent of dural attachment may influence the decision for an adequate approach. DISCUSSION Various approaches to the anterior cranial fossa exist, each with corresponding advantages and disadvantages. Recently, endoscopic approaches have increasingly been used. In this review, the different approaches to meningiomas of the anterior cranial fossa in respect of anatomical issues, indications, and associated risks are discussed.
Collapse
|