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J Neurol Surg A Cent Eur Neurosurg 2013; 74(03): 152-161
DOI: 10.1055/s-0032-1325630
Original Article
Georg Thieme Verlag KG Stuttgart · New York

The Trans-Frontal-Sinus Subcranial Approach for Removal of Large Olfactory Groove Meningiomas: Surgical Technique and Comparison to Other Approaches

Nicola Boari
1   Department of Neurosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milano, Italy
,
Filippo Gagliardi
1   Department of Neurosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milano, Italy
,
Fabio Roberti
2   Department of Neurosurgery, Indian River Medical Center, Vero Beach, Florida, United States
3   Department of Neurological Surgery, The George Washington University, Washington, District of Columbia, United States
,
Lina Raffaella Barzaghi
1   Department of Neurosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milano, Italy
,
Anthony J. Caputy
3   Department of Neurological Surgery, The George Washington University, Washington, District of Columbia, United States
,
Pietro Mortini
1   Department of Neurosurgery, San Raffaele Scientific Institute, Vita-Salute University, Milano, Italy
› Author Affiliations
Further Information

Publication History

27 January 2012

17 April 2012

Publication Date:
01 October 2012 (online)

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Abstract

Background and Study Objective Several surgical approaches have been previously reported for the treatment of olfactory groove meningiomas (OGM).

The trans-frontal-sinus subcranial approach (TFSSA) for the removal of large OGMs is described, comparing it with other reported approaches in terms of advantages and drawbacks.

Material and Methods The TFSSA was performed on cadaveric specimens to illustrate the surgical technique.

Results The surgical steps of the TFSSA and the related anatomical pictures are reported. The approach was adopted in a clinical setting; a case illustration is reported to demonstrate the feasibility of the described approach and to provide intraoperative pictures.

Conclusion The TFSSA represents a possible route to treat large OGMs. The subcranial approach provides early devascularization of the tumor, direct tumor access from the base without traction on the frontal lobes, good overview of dissection of the optic nerves and anterior cerebral arteries, and dural reconstruction with pedicled pericranial flap.

Keywords

olfactory groove meningiomas - anterior cranial base - skull base approaches - surgical technique - anatomical study
 

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