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J Neurol Surg B Skull Base
DOI: 10.1055/a-2297-9055
Original Article

Surgical Approaches to Resection of Olfactory Groove Meningiomas: Comparative Meta-analysis of the Endoscopic Endonasal versus Transcranial and Unilateral versus Bilateral Approaches

Nolan J. Brown 
1   Department of Neurosurgery, University of California, Irvine, Orange, California, United States
,
Zach Pennington
2   Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
,
Saarang Patel
1   Department of Neurosurgery, University of California, Irvine, Orange, California, United States
,
Cathleen Kuo
3   School of Medicine, University at Buffalo Jacobs School of Medicine, Buffalo, New York, United States
,
Sachiv Chakravarti
4   Dana-Farber Cancer Institute, Dana-Farber Brigham Cancer Center, Boston, Massachusetts, United States
,
Nicholas E. Bui
5   Department of Neurosurgery, Loma Linda University School of Medicine, Loma Linda, California, United States
,
Julian Gendreau
6   Division of Biomedical Engineering, Johns Hopkins Whiting School of Engineering, Baltimore, Maryland, United States
,
Jamie J. Van Gompel 
2   Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States
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Abstract

Introduction Here we systematically review the extant literature to highlight the advantages of bilateral versus unilateral approaches and endoscopic endonasal (midline) approaches versus transcranial approaches for olfactory groove meningiomas, focusing on complications, extent of resection, and local recurrence rates.

Methods Three databases were queried to identify all primary prospective trials and retrospective series comparing outcomes following endoscopic endonasal versus transcranial approaches and unilateral versus bilateral craniotomy for surgical resection of olfactory groove meningiomas. All articles were screened by two independent authors and selected for formal analysis according to predefined inclusion/exclusion criteria.

Results Seven studies comprising 288 total patients (mean age 55.0 ± 24.6 years) met criteria for inclusion. In the three comparing the endoscopic endonasal (n = 21) versus transcranial (n = 32) approaches, there was no significant difference between the two with respect to gross total resection (p = 0.34) or rates of Simpson Grade 1 resection (p = 0.69). EEA demonstrated higher rates of overall complications (p < 0.01) including postoperative infection (p = 0.03). In the four studies comparing bilateral (n = 117) versus unilateral approaches (n = 118), overall complication rates (p < 0.01) and disease recurrence (p = 0.01) were higher with bilateral approaches. All surgery-related mortalities also occurred in the bilateral cohort (n = 7, 7.14%). Gross total resection (p = 0.63) and Simpson grade (p = 0.48) were comparable between approaches. Olfaction preservation was superior for unilateral approaches (p < 0.01).

Conclusions Though the literature is limited, current evidence suggests that the endoscopic endonasal approach may be favorable over conventional craniotomy for select olfactory groove meningioma patients. Where craniotomy is used, unilateral approaches appear to reduce complications and the risk of olfaction loss.

Keywords

olfactory groove meningioma - anterior skull base - endoscopic endonasal - transcranial - anosmia - cerebrospinal fluid - pterional


Publication History

Received: 25 October 2023

Accepted: 31 March 2024

Accepted Manuscript online:
02 April 2024

Article published online:
30 April 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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