Endoscopic Endonasal versus Transcranial Approach to Resection of Olfactory Groove Meningiomas: A Systematic Review

Background: Despite the increasing utility of the endoscopic endonasal approach (EEA) for the management of anterior skull base (ASB) pathologies, the optimal treatment strategy for olfactory groove meningiomas (OGM) remains unclear.

Objective: This project sought to systematically compare outcomes of EEA management to the conventional transcranial approach (TCA) for the treatment of OGMs.

Methods: A systematic review was performed to identify studies that compared outcomes following EEA and TCA for OGMs. Data extracted from each study included gross total resection (GTR), incidence of cerebrospinal fluid (CSF) leaks, and postoperative complications including anosmia.

Results: The results of the search yielded five studies that met the criteria for inclusion and analysis. All studies compared TCA (n = 922) to EEA (n = 141) outcomes for OGMs. Overall, the rate of gross total resection (GTR) was lower among the endoscopic group (70.9%) relative to the transcranial group (91.5%). The rate of postoperative CSF leak were 6.3% versus 25.5% for the transcranial and endoscopic groups, respectively. Postoperative anosmia was higher for patients undergoing EEA (95.9%) compared with patients in the transcranial group (37.4%).

Conclusion: In this analysis, EEA was associated with a lower rate of GTR and higher incidences of CSF leaks and postoperative anosmia. However, with increasing surgeon familiarity with the endoscopic anatomy and technique for managing ASB pathologies, a nuanced approach may be used to minimize patient morbidity and widen the spectrum of skull base surgery.

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