Olfactory groove meningioma with a 10-year history of smell loss and olfactory recovery after surgery

A rare cause of olfactory impairment is olfactory groove meningiomas with insidious onset of non-specific symptoms like headache, olfactory dysfunction, psychiatric symptoms such as depression, personality changes, declining cognitive function, visual disturbances or seizures. A common complication of surgery is loss of olfactory function. Still, the preservation of olfactory function should be attempted as olfactory loss often has a severe negative impact on quality of life. This report describes a woman with an olfactory groove meningioma and a 10-year history of olfactory impairment. It includes preoperatively and postoperatively extended olfactory testing, a neurosurgical approach to preserve the olfactory function and postoperative olfactory rehabilitation. After rehabilitation, the patient regained a normal olfactory function, even though the right-sided olfactory nerve could not be preserved during surgery. The case demonstrates the importance of performing neuroimaging in selected patients with olfactory loss and a method for preserving and potentially improving postoperative olfactory function.

Smell loss as initial symptom of olfactory groove meningioma

Approximately 20% of the general population suffer from olfactory dysfunction (OD). Until today, olfactory function (OF) receives less attention than other human senses despite its significance for quality of life. The main causes of OD are upper respiratory tract infections, traumatic brain injuries and sinonasal diseases. Here, we report the case of a 28-year-old woman, who started to suffer from OD during pregnancy. Smell loss was attributed to pregnancy-induced rhinitis and initiated no further examinations. Nevertheless, OD persisted post partum and undulating headache occurred 1 year later. Only after visual impairment and one more year passing by, diagnosis of olfactory groove meningioma was made using MRI. With this case report, we want to highlight the importance of the symptom of smell loss. Patients reporting OD should undergo thorough anamnesis, endoscopy of the nasal cavity, psychophysical smell testing and radiographic imaging in unclear cases to determine diagnosis.

Outcome of Sellar and Suprasellar Brain Tumors with Retractorless Modified Subfrontal Approach

Aim: To determine the outcome of sellar and suprasellar brain tumors with retractorless modified subfrontal approach. Study design: Descriptive/observational study Place and duration of study: Department of Neurosurgery, Liaquat University Hospital Hyderabad/Jamshoro from 1st March 2020 to 28th February 2021. Methodology: Fifty patients of sellar and suprasellar brain tumors age between 15-70 years were enrolled. Patients details demographics age, sex and body mass index were recorded after taking written consent. The inter-hemispheric front-basal technique was used for all patients and the average follow-up time was 6 months. Postoperatively, magnetic resonance imaging (MRI) and computerized tomography (CT) scans in all patients were performed. After 12 hours, the postoperative CT scan was performed to monitor for persistent tumor and hemorrhage cerebral edema following an operation. Results: There were 30 (60%) male patients and 20 (40%) female patients. Mean age of the patients were 28.36±14.88 years with mean BMI 23.16±7.54 kg/m2. Most of the patients 20(40%) were from age group 15-30 years, followed by 31-40 years in 12 (24%) patients. Frequency of pituitary adenoma was found in 22 (44%) cases, craniopharyngioma found in 19 (38.7%) cases, arachnoid cyst found in 4 (8%), keratin flakes in 2 (4%) cases, benign giant cell tumor found in 2 (4%)olfactory groove meningioma in 1 (2%) and epidermoid in 1 (2%) cases. Post operatively 35 (70%) patients were completely recovered, complications found in 13 (26%) patients who were recovered later and frequency of not recovered patients was 2 (4%). According to Karnofsky performance, 16 (32%) patients had scale 30, scale 60 was in 2 (4%) cases, scale 70 in 4 (8%) patients, scale 80 in 19 (38%) and scale 90 in 9 (18%). Conclusion: This retractorless method is very effective and safe in the sellar and suprasellar region for excision of big tumors. This method allows the huge tumor to be removed without serious complication. Keywords: Sub-frontal approach, Sellar, Suprasellar, Brain tumor, Retractorless method

Recurrent Olfactory Groove Meningioma Filling the Nasal Cavity: A Case Report and Technical Video

Background Meningiomas are usually benign tumors and account for 15% of the overall intracranial tumors. Less than 3% of them extend up to the sinonasal region. Case Report A 61-year-old woman, operated on for a huge olfactory meningioma 8 years before, came for progressive nasal obstruction. On physical examination, a mass that completely obliterated the right nasal passage was detected. A c.e. cranial MRI confirmed the presence of an enhancing mass completely occupying the right nostril, without intracranial extension. A biopsy of the mass revealed a meningioma (WHO grade I) and the patient was admitted to our department for the surgical removal of the endonasal recurrent tumor. Results The meningioma was approached and excised by endonasal endoscopic approach using a microdebrider and electrocautery. A linear residual of tumor was left attached to the previous anterior skull base’ vascularized galeal flap, in order to avoid a communication with the intracranial compartment and a possible cerebrospinal fluid (CSF) leak. The postoperative course was uneventful, and the patient immediately referred an improvement in breathing. A c.e. postoperative MRI confirmed the nearly total removal of tumor. Conclusions We present a video with the most relevant steps of transnasal endoscopic surgical removal of a quite rare case of a recurrent olfactory groove meningioma, completely obliterating the right nostril.

Gender-affirming hormone therapy associated with multiple meningiomas and atypical histology in a transgender woman

We present a 69-year-old transgender woman who underwent gender-affirming surgery in 1998 and gender-affirming hormone therapy (cyproterone acetate (CPA) and estradiol) since this time. Following an MRI scan to investigate tremor in 2013, an incidental left anterior clinoid and right petrous meningioma were identified. Subtotal surgical resection was achieved for the anterior clinoid meningioma (WHO grade 1, meningothelial subtype). At follow-up in 2016, an olfactory groove meningioma and left greater wing of sphenoid meningioma were identified. By 2017, both tumours, along with the petrous meningioma, demonstrated significant growth. In 2018, clinical decline was evident and MRI demonstrated further tumour growth. Surgery was scheduled and the olfactory groove meningioma was completely resected (WHO grade 2, chordoid subtype). Hormones were stopped, after which regression of the petrous meningioma was observed. This case demonstrates an association between high-dose CPA and estradiol and the development, growth and regression of meningiomas in a transgender woman.

Nuances of Olfactory Groove Meningioma Surgery: 2-Dimensional Operative Video

Olfactory groove meningiomas frequently present as large or giant-size tumors associated with marked frontal lobe edema and significant frontal lobe dysfunction. Simpson grade I removal was rare in early reports due to their invasion of the ethmoid sinuses and skull base bone,1 which resulted in high recurrence rates.2,3 Indeed, recurrence occurred in the most celebrated case of olfactory groove meningioma.4,5 To achieve Simpson grade I removal (tumor, dura, bone), protect the frontal lobes from additional injury, and provide the best chance for recovery, we demonstrate a few nuances for olfactory groove meningioma surgery: Utilizing a skull base approach with a low dural opening, the frontal veins are preserved, and the frontal lobe is protected from retraction, manipulation, and venous injury. By the time of diagnosis, although the patient's olfaction is often absent, there still remains a role to preserve at least 1 olfactory tract, which might yield some preservation in a limited number of patients. Emphasis has been rightly made on the preservation of the A2 segments, which can be dissected using microsurgical technique. Lastly, multilayer reconstruction of the skull base is required, using an inlay graft, resting on a vascularized pericranial flap, and occlusion of the sinuses with a fat graft. The endonasal endoscopic approach has fallen out of favor due to limitations for complete tumor resection and higher complication rates.6 We present a case of a relatively small olfactory groove meningioma in a 36-yr-old male with partial olfactory loss. The patient consented for surgery. Images at 2:07, 2:29, and 2:54 from Al-Mefty O, Operative Atlas of Meningiomas, © LWW, 1997, with permission. Image at 8:31 public domain by age.