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J Neurol Surg B Skull Base 2013; 74(02): 097-102
DOI: 10.1055/s-0033-1333618
Original Article
Georg Thieme Verlag KG Stuttgart · New York

The Role of the Pterional Approach in the Surgical Treatment of Olfactory Groove Meningiomas: A 20-year Experience

Andrej D. Bitter
1   Department of Neurosurgery, Klinikum Duisburg, Duisburg NRW, Germany
,
Lampis C. Stavrinou
2   Department of Neurosurgery, Evangelisches Krankenhaus Bielefeld, Bielefeld NRW, Germany
,
Georgios Ntoulias
1   Department of Neurosurgery, Klinikum Duisburg, Duisburg NRW, Germany
,
Athanasios K. Petridis
1   Department of Neurosurgery, Klinikum Duisburg, Duisburg NRW, Germany
,
Morina Dukagjin
1   Department of Neurosurgery, Klinikum Duisburg, Duisburg NRW, Germany
,
Martin Scholz
1   Department of Neurosurgery, Klinikum Duisburg, Duisburg NRW, Germany
,
Werner Hassler
1   Department of Neurosurgery, Klinikum Duisburg, Duisburg NRW, Germany
› Author Affiliations
Further Information

Publication History

26 June 2012

19 October 2012

Publication Date:
22 January 2013 (online)

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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.

Keywords

pterional approach - olfactory groove meningiomas - surgical treatment - meningioma removal
 

  • References

  • 1 Aguiar PH, Tahara A, Almeida AN , et al. Olfactory groove meningiomas: approaches and complications. J Clin Neurosci 2009; 16: 1168-1173
    CrossrefPubMedGoogle Scholar
  • 2 Yamashita J, Handa H, Iwaki K, Abe M. Recurrence of intracranial meningiomas, with special reference to radiotherapy. Surg Neurol 1980; 14: 33-40
    PubMedGoogle Scholar
  • 3 Bakay L. Olfactory meningiomas. The missed diagnosis. JAMA 1984; 251: 53-55
    CrossrefPubMedGoogle Scholar
  • 4 Hassler W, Zentner J. Pterional approach for surgical treatment of olfactory groove meningiomas. Neurosurgery 1989; 25: 942-945 , discussion 945–947
    CrossrefPubMedGoogle Scholar
  • 5 Fatemi N, Dusick JR, de Paiva Neto MA, Malkasian D, Kelly DF. Endonasal versus supraorbital keyhole removal of craniopharyngiomas and tuberculum sellae meningiomas. Neurosurgery 2009; 64 (5) (Suppl. 02) 269-284 , discussion 284–286
    Google Scholar
  • 6 Reisch R, Perneczky A. Ten-year experience with the supraorbital subfrontal approach through an eyebrow skin incision. Neurosurgery 2005; 57 (4, Suppl) 242-255 , discussion 242–255
    Google Scholar
  • 7 van Lindert EJ, Grotenhuis JA. The combined supraorbital keyhole-endoscopic endonasal transsphenoidal approach to sellar, perisellar and frontal skull base tumors: surgical technique. Minim Invasive Neurosurg 2009; 52: 281-286
    Article in Thieme ConnectPubMedGoogle Scholar
  • 8 Figueiredo EG, Deshmukh V, Nakaji P , et al. An anatomical evaluation of the mini-supraorbital approach and comparison with standard craniotomies. Neurosurgery 2006; 59 (4) (Suppl. 02) ONS212-ONS220 , discussion ONS220
    Google Scholar
  • 9 Mayfrank L, Gilsbach JM. Interhemispheric approach for microsurgical removal of olfactory groove meningiomas. Br J Neurosurg 1996; 10: 541-545
    CrossrefPubMedGoogle Scholar
  • 10 van Lindert E, Perneczky A, Fries G, Pierangeli E. The supraorbital keyhole approach to supratentorial aneurysms: concept and technique. Surg Neurol 1998; 49: 481-489 , discussion 489–490
    CrossrefPubMedGoogle Scholar
  • 11 Arita N, Mori S, Sano M , et al. Surgical treatment of tumors in the anterior skull base using the transbasal approach. Neurosurgery 1989; 24: 379-384
    CrossrefPubMedGoogle Scholar
  • 12 Dave SP, Bared A, Casiano RR. Surgical outcomes and safety of transnasal endoscopic resection for anterior skull tumors. Otolaryngol Head Neck Surg 2007; 136: 920-927
    CrossrefPubMedGoogle Scholar
  • 13 van Furth WR, Agur AM, Woolridge N, Cusimano MD. The orbitozygomatic approach. Neurosurgery 2006; 58 (1, Suppl) ONS103-ONS107 , discussion ONS103–ONS107
    PubMedGoogle Scholar
  • 14 El-Bahy K. Validity of the frontolateral approach as a minimally invasive corridor for olfactory groove meningiomas. Acta Neurochir (Wien) 2009; 151: 1197-1205
    CrossrefPubMedGoogle Scholar
  • 15 Solero CL, Giombini S, Morello G. Suprasellar and olfactory meningiomas. Report on a series of 153 personal cases. Acta Neurochir (Wien) 1983; 67: 181-194
    CrossrefPubMedGoogle Scholar
  • 16 Tsikoudas A, Martin-Hirsch DP. Olfactory groove meningiomas. Clin Otolaryngol Allied Sci 1999; 24: 507-509
    PubMedGoogle Scholar
  • 17 Bassiouni H, Asgari S, Stolke D. Olfactory groove meningiomas: functional outcome in a series treated microsurgically. Acta Neurochir (Wien) 2007; 149: 109-121 , discussion 121
    CrossrefPubMedGoogle Scholar
  • 18 Gazzeri R, Galarza M, Gazzeri G. Giant olfactory groove meningioma: ophthalmological and cognitive outcome after bifrontal microsurgical approach. Acta Neurochir (Wien) 2008; 150: 1117-1125 , discussion 1126
    CrossrefPubMedGoogle Scholar
  • 19 Hentschel SJ, DeMonte F. Olfactory groove meningiomas. Neurosurg Focus 2003; 14: e4
    PubMedGoogle Scholar
  • 20 Mirimanoff RO, Dosoretz DE, Linggood RM, Ojemann RG, Martuza RL. Meningioma: analysis of recurrence and progression following neurosurgical resection. J Neurosurg 1985; 62: 18-24
    CrossrefPubMedGoogle Scholar
  • 21 Nakamura M, Struck M, Roser F, Vorkapic P, Samii M. Olfactory groove meningiomas: clinical outcome and recurrence rates after tumor removal through the frontolateral and bifrontal approach. Neurosurgery 2008; 62 (6) (Suppl. 03) 1224-1232
    PubMedGoogle Scholar
  • 22 Obeid F, Al-Mefty O. Recurrence of olfactory groove meningiomas. Neurosurgery 2003; 53: 534-542 , discussion 542–543
    CrossrefPubMedGoogle Scholar
  • 23 Romani R, Lehecka M, Gaal E , et al. Lateral supraorbital approach applied to olfactory groove meningiomas: experience with 66 consecutive patients. Neurosurgery 2009; 65: 39-52 , discussion 52–53
    CrossrefPubMedGoogle Scholar
  • 24 Schaller C, Rohde V, Hassler W. Microsurgical Removal of Olfactory Groove Meningiomas via the Pterional Approach. Skull Base Surg 1994; 4: 189-192
    Article in Thieme ConnectPubMedGoogle Scholar
  • 25 Spektor S, Valarezo J, Fliss DM , et al. Olfactory groove meningiomas from neurosurgical and ear, nose, and throat perspectives: approaches, techniques, and outcomes. Neurosurgery 2005; 57 (4, Suppl) 268-280 , discussion 268–280
    CrossrefPubMedGoogle Scholar
  • 26 Turazzi S, Cristofori L, Gambin R, Bricolo A. The pterional approach for the microsurgical removal of olfactory groove meningiomas. Neurosurgery 1999; 45: 821-825 , discussion 825–826
    CrossrefPubMedGoogle Scholar
  • 27 Maiuri F, Salzano FA, Motta S, Colella G, Sardo L. Olfactory groove meningioma with paranasal sinus and nasal cavity extension: removal by combined subfrontal and nasal approach. J Craniomaxillofac Surg 1998; 26: 314-317
    CrossrefPubMedGoogle Scholar
  • 28 El Gindi S. Olfactory groove meningioma: surgical techniques and pitfalls. Surg Neurol 2000; 54: 415-417
    CrossrefPubMedGoogle Scholar
  • 29 Sekhar LN, Nanda A, Sen CN, Snyderman CN, Janecka IP. The extended frontal approach to tumors of the anterior, middle, and posterior skull base. J Neurosurg 1992; 76: 198-206
    CrossrefPubMedGoogle Scholar
  • 30 Paterniti S, Fiore P, Levita A, La Camera A, Cambria S. Basal meningiomas. A retrospective study of 139 surgical cases. J Neurosurg Sci 1999; 43: 107-113 , discussion 113–114
    PubMedGoogle Scholar
  • 31 de Divitiis E, Esposito F, Cappabianca P, Cavallo LM, de Divitiis O, Esposito I. Endoscopic transnasal resection of anterior cranial fossa meningiomas. Neurosurg Focus 2008; 25: E8
    PubMedGoogle Scholar
  • 32 Liu JK, Christiano LD, Patel SK, Tubbs RS, Eloy JA. Surgical nuances for removal of olfactory groove meningiomas using the endoscopic endonasal transcribriform approach. Neurosurg Focus 2011; 30: E3
    PubMedGoogle Scholar
  • 33 Rachinger W, Grau S, Tonn JC. Different microsurgical approaches to meningiomas of the anterior cranial base. Acta Neurochir (Wien) 2010; 152: 931-939
    CrossrefPubMedGoogle Scholar
  • 34 Fernandez-Miranda JC, Gardner PA, Prevedello DM, Kassam AB. Expanded endonasal approach for olfactory groove meningioma. Acta Neurochir (Wien) 2009; 151: 287-288 , author reply 289–290
    CrossrefPubMedGoogle Scholar
  • 35 Gardner PA, Kassam AB, Thomas A , et al. Endoscopic endonasal resection of anterior cranial base meningiomas. Neurosurgery 2008; 63: 36-52 , discussion 52–54
    CrossrefPubMedGoogle Scholar
  • 36 Webb-Myers R, Wormald PJ, Brophy B. An endoscopic endonasal technique for resection of olfactory groove meningioma. J Clin Neurosci 2008; 15: 451-455
    CrossrefPubMedGoogle Scholar
  • 37 Seeger W. Frontobasal operations. In: Microsurgery of the Cranial Base. Berlin: Springer-Verlag; 1983: 200-269
    CrossrefGoogle Scholar
  • 38 Kemp LG, VanderArk GD. Anterior communicating artery aneurysms. Gyrus rectus approach. Neurochirurgia (Stuttg) 1971; 14: 63-70
    PubMedGoogle Scholar
  • 39 Krekorian EA, Kempe LG. The combined otolaryngology-neurosurgery approach to extensive benign tumors. Laryngoscope 1969; 79: 2086-2103
    CrossrefPubMedGoogle Scholar