Transfrontal-Sinus-Subcranial Approach to Olfactory Groove Meningiomas: Surgical Results and Clinical and Functional Outcome in a Consecutive Series of 21 Patients

LR Barzaghi, A Spina, F Gagliardi, N Boari, P Mortini

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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. © 2017 Elsevier Inc.
Original languageEnglish
Pages (from-to)315-324
Number of pages10
JournalWorld Neurosurgery
Volume101
Issue number1
DOIs
Publication statusPublished - 2017

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Meningioma
Neoplasms
Olfaction Disorders
Karnofsky Performance Status
Smell
Skull Base
Survival Rate
Magnetic Resonance Imaging
Morbidity
Recurrence
Mortality
Brain

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Transfrontal-Sinus-Subcranial Approach to Olfactory Groove Meningiomas: Surgical Results and Clinical and Functional Outcome in a Consecutive Series of 21 Patients. / Barzaghi, LR; Spina, A; Gagliardi, F; Boari, N; Mortini, P.

In: World Neurosurgery, Vol. 101, No. 1, 2017, p. 315-324.

Research output: Contribution to journalArticle

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title = "Transfrontal-Sinus-Subcranial Approach to Olfactory Groove Meningiomas: Surgical Results and Clinical and Functional Outcome in a Consecutive Series of 21 Patients",
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. {\circledC} 2017 Elsevier Inc.",
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AU - Boari, N

AU - Mortini, P

PY - 2017

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N2 - 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. © 2017 Elsevier Inc.

AB - 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. © 2017 Elsevier Inc.

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