PMCCPMCCPMCC

Search tips
Search criteria 

Advanced

 
Logo of skullbasesurgInstructions for AuthorsSubscribe to Skull BaseAbout Skull BaseEditorial BoardThieme Medical PublishingSkull Base An Interdisciplinary Approach ...
 
Skull base surgery. 1999; 9(1): 23–31.
PMCID: PMC1656717

Giant Olfactory Meningiomas

The Pterional Approach and Its Relevance for Minimizing Surgical Morbidity

Abstract

Olfactory groove meningiomas may attain surprisingly large size. The subfrontal approach is currently the route preferred by most neurosurgeons for their excision. The pterional-transsylvian route represents an alternate exposure for microsurgery of frontobasal tumors. Although this approach has been already described for olfactory meningiomas, tumors of giant size were not specifically addressed in the literature. We report the application of the pterional-transsylvian approach in six patients with giant olfactory meningiomas. This series is unique because it includes only patients with tumors exceeding 6 cm in diameter with bilateral symmetrical development. A radical removal was achieved in all patients and all of them made a full recovery. To investigate the relevance of the pterional-transsylvian approach for minimizing surgical morbidity, a magnetic resonance imaging protocol was designed to characterize even subtle postoperative frontal lobe structural changes. These changes, limited to the frontal lobe ipsilateral to exposure and localized in specific anatomical domains of the prefrontal area, included cystic degenerative alterations, parenchymal gliosis, and associated persistent white matter edema. Results from the present series strengthen the usefulness of the pterional-transsylvian approach as a safe surgical route for lesions affecting the anterior skull base, even with huge bilateral symmetrical expansion, such as giant olfactory meningiomas.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (3.6M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Bakay L. Olfactory meningiomas. The missed diagnosis. JAMA. 1984 Jan 6;251(1):53–55. [PubMed]
  • Ojemann RG, Thornton AF, Harsh GR. Management of anterior cranial base and cavernous sinus neoplasms with conservative surgery alone or in combination with fractionated photon or stereotactic proton radiotherapy. Clin Neurosurg. 1995;42:71–98. [PubMed]
  • Solero CL, Giombini S, Morello G. Suprasellar and olfactory meningiomas. Report on a series of 153 personal cases. Acta Neurochir (Wien) 1983;67(3-4):181–194. [PubMed]
  • Hassler W, Zentner J. Pterional approach for surgical treatment of olfactory groove meningiomas. Neurosurgery. 1989 Dec;25(6):942–947. [PubMed]
  • Schaller C, Rohde V, Hassler W. Microsurgical Removal of Olfactory Groove Meningiomas via the Pterional Approach. Skull Base Surg. 1994;4(4):189–192. [PMC free article] [PubMed]
  • KARNOFSKY DA, BURCHENAL JH, ARMISTEAD GC, Jr, SOUTHAM CM, BERNSTEIN JL, CRAVER LF, RHOADS CP. Triethylene melamine in the treatment of neoplastic disease; a compound with nitrogen-mustardlike activity suitable for oral and intravenous use. AMA Arch Intern Med. 1951 Apr;87(4):477–516. [PubMed]
  • Salpietro FM, Alafaci C, Lucerna S, Iacopino DG, Todaro C, Tomasello F. Peritumoral edema in meningiomas: microsurgical observations of different brain tumor interfaces related to computed tomography. Neurosurgery. 1994 Oct;35(4):638–642. [PubMed]
  • Tsuchiya K, Mizutani Y, Hachiya J. Preliminary evaluation of fluid-attenuated inversion-recovery MR in the diagnosis of intracranial tumors. AJNR Am J Neuroradiol. 1996 Jun-Jul;17(6):1081–1086. [PubMed]
  • Stuss DT, Benson DF. Neuropsychological studies of the frontal lobes. Psychol Bull. 1984 Jan;95(1):3–28. [PubMed]
  • Hassler W, Zentner J. Pterional approach for surgical treatment of olfactory groove meningiomas. Neurosurgery. 1989 Dec;25(6):942–947. [PubMed]
  • Babu R, Barton A, Kasoff SS. Resection of olfactory groove meningiomas: technical note revisited. Surg Neurol. 1995 Dec;44(6):567–572. [PubMed]
  • Mayfrank L, Gilsbach JM. Interhemispheric approach for microsurgical removal of olfactory groove meningiomas. Br J Neurosurg. 1996 Dec;10(6):541–545. [PubMed]
  • Alaywan M, Sindou M. Facteurs pronostiques dans la chirurgie des méningiomes intracrâniens. Rôle de la taille de la tumeur et de sa vascularisation artérielle d'origine pie-mérienne. Etude sur 150 cas. Neurochirurgie. 1993;39(6):337–347. [PubMed]
  • Kadis GN, Mount LA, Ganti SR. The importance of early diagnosis and treatment of the meningiomas of the planum sphenoidale and tuberculum sellae: a retrospective study of 105 cases. Surg Neurol. 1979 Nov;12(5):367–371. [PubMed]
  • Symon L, Rosenstein J. Surgical management of suprasellar meningioma. Part 1: The influence of tumor size, duration of symptoms, and microsurgery on surgical outcome in 101 consecutive cases. J Neurosurg. 1984 Oct;61(4):633–641. [PubMed]
  • De Coene B, Hajnal JV, Gatehouse P, Longmore DB, White SJ, Oatridge A, Pennock JM, Young IR, Bydder GM. MR of the brain using fluid-attenuated inversion recovery (FLAIR) pulse sequences. AJNR Am J Neuroradiol. 1992 Nov-Dec;13(6):1555–1564. [PubMed]

Articles from Skull Base Surgery are provided here courtesy of Thieme Medical Publishers