scholarly journals OLFACTORY GROOVE MENINGIOMAS – CLINICAL PRESENTATION, TREATMENT AND OUTCOMES

2015 ◽  
Vol 2 (1) ◽  
pp. 34-48
Author(s):  
Tabita Larisa Cazac ◽  
Ioana Andreea Dărămuș ◽  
B. C. Dumitrescu ◽  
C. Toader
Keyword(s):  
Visual Acuity ◽  
Cribriform Plate ◽  
Anterior Cranial Fossa ◽  
External Carotid ◽  
Olfactory Groove ◽  
Mental Disturbances ◽  
Cranial Fossa ◽  
Frontal Sinuses ◽  
Planum Sphenoidale ◽  
Brain Retraction

Olfactory groove meningiomas are benign tumors, which arise in the midline of the anterior cranial fossa, over the cribriform plate and frontosphenoid suture. They represent approximately 10 percent of all intracranial meningiomas, more likely to occur in women in the fifth and sixth decades of life. They often involve the area from the grista galli to the posterior planum sphenoidale, and can be either simetric, bilateral or unilateral based on their midline origin. We report the case of a 45-year-old man who presented with an episode of loss of consciousness, progressive mental disturbances, impairment of visual acuity, anosmia and headache. Gadolinium-enhanced T1-weighted MR images showed a well-defined, hyperintense mass, located in the anterior cranial fossa, measuring 45/50/61 mm, with homogenous enhancement and a broad dural attachment to the cribriform plate, from crista galli to the planum sphenoidale. Preoperative Angiography revealed tumor vascularization from anterior and posterior ethmoidal arteries, branches of ophthalmic artery and branches of external carotid artery. The olfactory groove meningioma was successfully resected using a bifrontal approach with frontal sinuses opened in order to avoid brain retraction. Cranialization with pericranium of frontal sinuses was performed at the end of surgical procedure. Improvement of visual acuity was noted, mental disturbances and seizures remitted, but cerebrospinal leakage occurred, resolved via recranialization of frontal sinuses and lumbar punctions. The last postoperative computer-tomography investigation showed total surgical removal with no recurrence or residual tumor. Total tumor removal must be performed with coagulation of its arachnoid attachments and resection of hyperostotic bone in order to avoid recurrence, but with least brain retraction.

scholarly journals Endoscopic transnasal resection of anterior cranial fossa meningiomas

2008 ◽  
Vol 25 (6) ◽  
pp. E8 ◽  
Author(s):  
Enrico de Divitiis ◽  
Felice Esposito ◽  
Paolo Cappabianca ◽  
Luigi M. Cavallo ◽  
Oreste de Divitiis ◽  
...  
Keyword(s):  
Skull Base ◽  
Complete Recovery ◽  
Postoperative Recovery ◽  
Anterior Cranial Fossa ◽  
Csf Leak ◽  
Transnasal Approach ◽  
Olfactory Groove ◽  
Csf Leakage ◽  
Cranial Fossa ◽  
Brain Retraction

Object The extended transnasal approach, a recent surgical advancements for the ventral skull base, allows excellent midline access to and visibility of the anterior cranial fossa, which was previously thought to be approachable only via a transcranial route. The extended transnasal approach allows early decompression of the optic canals, obviates the need for brain retraction, and reduces neurovascular manipulation. Methods Between 2004 and 2007, 11 consecutive patients underwent transnasal resection of anterior cranial fossa meningiomas—4 olfactory groove (OGM) and 7 tuberculum sellae (TSM) meningiomas. Age at surgery, sex, symptoms, and imaging studies were reviewed. Tumor size and tumor extension were estimated, and the anteroposterior, vertical, and horizontal diameters were measred on MR images. Medical records, surgical complications, and outcomes of the patients were collected. Results A gross-total removal of the lesion was achieved in 10 patients (91%), and in 1 patient with a TSM only a near-total (> 90%) resection was possible. Four patients with preoperative visual function defect had a complete recovery, whereas 3 patients experienced a transient worsening of vision, fully recovered within few days. In 3 patients (2 with TSMs and 1 with an OGM), a postoperative CSF leak occurred, requiring a endoscopic surgery for skull base defect repair. Another patient (a case involving a TSM) developed transient diabetes insipidus. The operative time ranged from 6 to 10 hours in the OGM group and from 4.5 to 9 hours in the TSM group. The mean duration of the hospital stay was 13.5 and 10 days in the OGM and TSM groups, respectively. Six patients (3 with OGMs and 3 with TSMs) required a blood transfusion. Surgery-related death occurred in 1 patient with TSM, in whom the tumor was successfully removed. Conclusions The technique offers a minimally invasive route to the midline anterior skull base, allowing the surgeon to avoid using brain retraction and reducing manipulation of the large vessels and optic apparatus; hastens postoperative recovery; and improves patient compliance. Further assessment and refinement are required, particularly because of the potential risk of CSF leakage. Other studies and longer follow-up periods are necessary to ascertain the benefits of the technique.

scholarly journals Anterior Craniofacial (Transcranial) Resection for Tumors of Nose and Paranasal Sinuses: Surgical Technique

2011 ◽  
Vol 3 (3) ◽  
pp. 197-201
Author(s):  
Saurabh Varshney ◽  
SS Bist ◽  
Sarita Mishra ◽  
Charitesh Gupta ◽  
Sanjiv Bhagat ◽  
...  
Keyword(s):  
Paranasal Sinus ◽  
Paranasal Sinuses ◽  
Malignant Tumors ◽  
Cribriform Plate ◽  
Anterior Cranial Fossa ◽  
Craniofacial Resection ◽  
Csf Leakage ◽  
Cranial Fossa ◽  
The Mean ◽  
Nose And Paranasal Sinuses

ABSTRACT Background Management of nose and paranasal sinus tumors involving the cribriform plate with or without invasion of anterior cranial fossa is complex due to the anatomic detail of the region and the variety of tumors that occur in this area. Anterior craniofacial resection is recognized as the best treatment for nose and paranasal sinus, tumors involving the cribriform plate with or without invasion of anterior cranial fossa. Craniofacial resection allows wide exposure of the complex anatomical structures at the base of skull permitting monobloc tumor resection. Methods Twenty-one patients underwent anterior craniofacial resection for nose and paranasal sinus tumors involving the cribriform plate with or without invasion of anterior cranial fossa at Himalayan Institute of Medical Sciences, Dehradun between 2000 and 2011 by a team of head-neck surgeons and neurosurgeons. Results The series included 16 malignant tumors of the nose and paranasal sinuses and five extensive benign lesions. The mean age was 47.4 years (range, 12 to 68 years). There were 16 men and five women (M:F- 3.2:1.0). Four patients had a recurrence after previous treatments (surgery and/or radiotherapy). The histological subdivision was as follows: Seven cases of squamous cell carcinoma, four cases of adenocarcinoma, three cases of esthesioneuroblastoma, and two cases of undifferentiated tumors. All tumors were resected by a combined bifrontal craniotomy and rhinotomy. The skull base was closed with a pediculated pericranial flap and a split-thickness free skin graft underneath. There were no postoperative problems of CSF-leakage or meningitis, two patients had wound infection. Recurrent tumor growth or systemic metastasis occurred in three (18.75%) out of 16 patients with malignant tumors, 6 months to 2 years postoperatively. The mean follow-up was 16 months. Conclusion An anterior craniofacial resection should be performed in cases of nose and paranasal sinus tumors involving the cribriform plate with or without invasion of anterior cranial fossa.

scholarly journals THE PTERIONAL APPROACH IN A CASE OF PLANUM SPHENOIDALE MENINGIOMA

2018 ◽  
Vol 1 (3) ◽  
pp. 119-124
Author(s):  
Tabita Larisa Cazac ◽  
D. C. Ciotarla ◽  
Ioana Andreea Dărămuș ◽  
B. C. Dumitrescu
Keyword(s):  
Visual Acuity ◽  
Postoperative Outcome ◽  
Residual Tumor ◽  
Visual Disturbance ◽  
Visual Field Defects ◽  
Surgical Removal ◽  
Pterional Approach ◽  
Total Recovery ◽  
Olfactory Groove ◽  
Planum Sphenoidale

Meningiomas represent almost 15 percent of primary brain tumors and are the most common non-glial primary brain tumor. Parasellar meningiomas represent 5–10 percent of all intracranial meningiomas. They may arise from the diaphragma sella, tuberculum sellae, planum sphenoidale, medial lesser wing of sphenoid, anterior clinoid, clivus, and cavernous sinus (Smith 2005). Planum sphenoidale meningiomas are located anterior to and in proximity to the olfactory groove. For an optimal postoperative outcome planum, sphenoidale meningiomas must be diagnosed early, and the operative procedures performed promptly and with utmost care. Ideally, management is intended to preserve and improve vision and consists of total resection with no injury to the neighboring vital structures. We report the case of a 64-year-old woman who presented with progressive visual disturbance, impairment of visual acuity, visual field defects and diffuse headache. Gadolinium-enhanced T1-weighted MR images showed a well-defined, suprasellar solid mass, measuring 30/35/40 mm. The lesion was hyperintense on T1-weighted imaging with homogenous enhancement and a broad dural attachment to the planum sphenoidale. The planum sphenoidale meningioma was successfully resected using a left pterional approach. The intraoperative and postoperative courses were uneventful with a total recovery. Improvement of visual acuity was noted and the postoperative computer-tomography investigation showed total surgical removal with no residual tumor.

Surgical nuances for removal of olfactory groove meningiomas using the endoscopic endonasal transcribriform approach

2011 ◽  
Vol 30 (5) ◽  
pp. E3 ◽  
Author(s):  
James K. Liu ◽  
Lana D. Christiano ◽  
Smruti K. Patel ◽  
R. Shane Tubbs ◽  
Jean Anderson Eloy
Keyword(s):  
Nasal Cavity ◽  
Skull Base ◽  
Paranasal Sinuses ◽  
Endoscopic Endonasal ◽  
Olfactory Groove ◽  
Simpson Grade ◽  
Dural Attachment ◽  
Planum Sphenoidale ◽  
Brain Retraction ◽  
Neurovascular Structures

Olfactory groove meningiomas represent 10% of intracranial meningiomas and arise in the midline of the anterior cranial fossa along the dura of the cribriform plate and planum sphenoidale. Hyperostosis of the adjacent underlying bone is common, and further extension into ethmoid sinuses and nasal cavity can occur in 15%–25% of cases. Radical tumor resection including the involved dural attachment and underlying hyperostotic bone offers the best chance of a Simpson Grade I resection to minimize recurrence. Incomplete removal of involved hyperostotic bone can result in tumor recurrence at the cribriform plate with extension into the paranasal sinuses. Resection has traditionally been performed using a bifrontal or pterional approach, both of which require some degree of brain retraction or manipulation to expose the tumor. The endoscopic endonasal transcribriform approach offers the most direct and immediate exposure to the tumor without brain retraction and manipulation of neurovascular structures. An endonasal “keyhole craniectomy” is performed in the ventral skull base directly over the basal dural attachment, extending from the posterior wall of the frontal sinus to the planum sphenoidale and tuberculum sellae in the anteroposterior plane, and from one medial orbit to the other in the coronal plane. Excellent panoramic visualization of the keyhole skull base defect can be obtained with a 30° endoscope after performing a modified Lothrop procedure. Because the dural attachment is adjacent to the paranasal sinuses, early devascularization and total Simpson Grade I removal of the tumor including the dural attachment and underlying hyperostotic bone can be achieved in properly selected patients. This approach is also very suitable for meningiomas that have recurred or extended into the paranasal sinuses. Extracapsular, extraarachnoid dissection of the tumor from the frontal lobes and neurovascular structures can be performed using conventional bimanual microsurgical techniques. In this report, we review the surgical technique and describe our operative nuances for removal of olfactory groove meningiomas, including recurrent tumors with extension into the nasal cavity, using a purely endoscopic endonasal transcribriform approach. In addition, we discuss the advantages, limitations, patient selection, and complications of this approach. We specifically highlight our technique for multilayer reconstruction of large anterior skull base dural defects using fascia lata and acellular dermal allograft supplemented by bilateral vascularized pedicled nasoseptal flaps. Three new cases of endoscopically resected olfactory groove meningiomas are also presented.

Anterior Cranial Fossa Defects: Technical Account of Repair with an Open, Non-Buttressed Approach

2013 ◽  
Vol 74 (S 01) ◽  
Author(s):  
Chiazo Amene ◽  
Papireddy Bollam ◽  
Minervia Nixon ◽  
Anil Nanda ◽  
Bharat Guthikonda
Keyword(s):  
Anterior Cranial Fossa ◽  
Cranial Fossa

scholarly journals Transnasal flow reduction in endovascular treatment for anterior cranial fossa dural arteriovenous fistula

2020 ◽  
Vol 2020 (10) ◽  
Author(s):  
Shuhei Kawabata ◽  
Hajime Nakamura ◽  
Takeo Nishida ◽  
Masatoshi Takagaki ◽  
Nobuyuki Izutsu ◽  
...  
Keyword(s):  
Blood Flow ◽  
Endovascular Treatment ◽  
Arteriovenous Fistula ◽  
Dural Arteriovenous Fistula ◽  
Transarterial Embolization ◽  
Anterior Cranial Fossa ◽  
Maxillary Artery ◽  
Flow Reduction ◽  
Cranial Fossa ◽  
Embolic Materials

ABSTRACT Transarterial embolization (TAE) is a useful option for anterior cranial fossa–dural arteriovenous fistula (ACF–dAVF) as endovascular devices have progressed. Liquid agents are usually injected via a microcatheter positioned just proximal to the shunt pouch beyond the ophthalmic artery; however, high blood flow from the internal maxillary artery (IMA) often impedes penetration of embolic materials into the shunt pouch. Therefore, reducing blood flow from the IMA before embolization can increase the success rate. In the present case, to reduce blood flow from branches of the IMA, we inserted surgical gauze infiltrated with xylocaine and epinephrine into bilateral nasal cavities. Using this method, we achieved curative TAE with minimal damage to the nasal mucosa. Transnasal flow reduction is an easy, effective and minimally invasive method. This method should be considered in the endovascular treatment of ACF–dAVF, especially in patients with high blood flow from theIMA.

Pterional Approach for Surgical Treatment of Olfactory Groove Meningiomas

Neurosurgery ◽  
1989 ◽  
Vol 25 (6) ◽  
pp. 942-947 ◽  
Author(s):  
W. Hassler ◽  
J. Zentner
Keyword(s):  
Surgical Treatment ◽  
Superior Sagittal Sinus ◽  
Cerebrospinal Fluid Fistula ◽  
Pterional Approach ◽  
Olfactory Groove ◽  
Sagittal Sinus ◽  
Frontal Brain ◽  
Bridging Veins ◽  
Frontal Sinuses ◽  
Fluid Fistula

Abstract We present our experience with the surgical treatment of olfactory groove meningiomas using a pterional approach. This approach provides the advantages of previous techniques, such as preserving the frontal brain and superior sagittal sinus, early devascularization of the tumor, and late dissection of tumor borders. Moreover, it also compensates for the shortcomings of other techniques, e.g., compression of frontal bridging veins, late dissection of dorsal tumor aspects involving vessels and optic nerves as well as facultative infection and cerebrospinal fluid fistula-related complications caused by opening of frontal sinuses. To date, 11 patients were treated in this way. As we encountered no surgical complications in our series we are encouraged to present our procedure.

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