Olfactory Functional Status Following Extended Endoscopic Endonasal Approach for Suprasellar Meningiomas

Background: A growing body of evidence is available demonstrating the superiority of the endoscopic endonasal approach (EEA) compared with transcranial (TCA) for tuberculum sellae (TS)/planum sphenoidale (PS) meningioma in terms of visual outcome, seizures, and stroke. Hyposmia/ageusia and CSF leak were reported among the common complications following EEA for TS/PS meningiomas.

Objective: To study the outcomes of the olfactory function in a patient who underwent EEA for suprasellar meningioma in our institution and to review technical points that lead to a better prognosis.

Methods: We have conducted a retrospective study for suprasellar meningioma cases that was resected through EEA between 2015 and 2021 with the focus on olfactory status which was assessed using the visual analog scale (VAS) at four points of time (baseline, then 3, 6, and 12 months postoperative) and classified into normal (0), mild (1–3), moderate (4–7) or severe (8–10) smell loss. The origin of the meningioma was classified into diaphragma sella (type A), TS (type B), chiasmatic sulcus (type C), PS (type D), and others. Demographic data, the extent of resection, postoperative complications, and operative notes were evaluated.

Results: A total of 23 consecutive patients were included. The median age was 43 years, 87% females. 31% (7 patients) were type B, 26% type C, and 26% type D meningioma. A gross total excision achieved in 82%. Among all patient 26% presented with impaired smell function pre-operatively (9% mild, 4% moderate, and 13% sever). While only 8.6% (2 patients) expressed severe change in the VAS score at 12-month follow-up. At 3-month follow-up the moderate change in the VAS score was 26% (6 patients), 83% of them had improvement to a mild smell dysfunction at 6-month follow-up. In our cohort 13% had a severe smell dysfunction (one patient had impaired smell dysfunction preoperative). 52% had no change in the VAS score throughout the follow-up period. The average change in the VAS score dropped significantly from −5 in the first 2 years to −0.85 in the last 2 years.

Conclusion: The risk of smell dysfunction following EEA for suprasellar meningioma is almost comparable to the transcranial approach. The risk of change in the VAS score remarkably decreases with the increase in the learning curve, and this could predict the shifting of the practice to utilize the EEA as a standard of care for suprasellar meningiomas.

Publication History

Article published online:
01 February 2023