Skip to main content
SpringerLink
Log in

16 Olfactory Groove Meningiomas

  • Chapter
  • First Online:
Endoscopic and Keyhole Cranial Base Surgery

Abstract

Olfactory groove meningiomas arise from the dura around the cribriform plate and can span the anterior skull base from the crista galli to the tuberculum sella, often involving the optic pathway and anterior circulation. While there are a variety of open surgical approaches to these lesions, it is important to select the optimal approach to provide adequate exposure of the tumor and involved dura, bone, and vasculature, as well as to allow for reconstruction and closure. Postoperative complications, including cerebral edema and cerebrospinal fluid leak, may be prevented by carefully selecting and planning an appropriate surgical approach for a given lesion. In 16.2, we review the merits and drawbacks of open transcranial approaches for olfactory groove meningiomas and discuss our recommended surgical approaches and management considerations. In 16.3, we demonstrate that the supraorbital eyebrow keyhole approach allows gross total resection of small- and medium-sized olfactory groove meningiomas. The cosmetic result is usually excellent. The complications rate is low. Because of the low height of the craniotomy, visualization of the olfactory groove requires frequently endoscope assistance especially when the olfactory groove is very steep. The rate of CSF leakage and loss of olfaction is lower than with the endonasal approach. Therefore, we consider the supraorbital eyebrow approach as the procedure of choice for most olfactory groove meningiomas. In 16.4, we demonstrate that olfactory groove meningiomas are lesions of the frontal skull base that also can be approached via a transcranial route from above or an endoscopic transnasal route from below. There are three main parts of transnasal endoscopic skull base approaches for olfactory groove meningiomas: the transethmoidal, transcribriform, and transplanum. The approach can be optimally tailored to the tumor size and surgical situation, with the opening as large as necessary but as minimally invasive as possible. There are special considerations concerning patient selection and surgical technique to make an appropriate decision about the optimal approach. A successful result will owe a great deal to careful patient selection, detailed planning, and a dedicated surgical team.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 119.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 159.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References (Key References Bolded)

  1. Chan RC, Thompson GB. Morbidity, mortality, and quality of life following surgery for intracranial meningiomas. A retrospective study in 257 cases. J Neurosurg. 1984;60(1):52–60.

    Article  CAS  PubMed  Google Scholar 

  2. Solero CL, Giombini S, Morello G. Suprasellar and olfactory meningiomas. Report on a series of 153 personal cases. Acta Neurochir. 1983;67(3–4):181–94.

    Article  CAS  PubMed  Google Scholar 

  3. Cushing H, Eisenhardt L. Meningiomas: their classification, regional behavior, life history, and surgical end results. Springfield: Charles C. Thomas; 1938. p. 250–82.

    Google Scholar 

  4. Zygourakis CC, Sughrue ME, Benet A, Parsa AT, Berger MS, McDermott MW. Management of planum/olfactory meningiomas: predicting symptoms and postoperative complications. World Neurosurg. 2014;82(6):1216–23.

    Article  PubMed  Google Scholar 

  5. McDermott MW, Rootman J, Durity FA. Subperiosteal, subperiorbital dissection and division of the anterior and posterior ethmoid arteries for meningiomas of the cribriform plate and planum sphenoidale: technical note. Neurosurgery. 1995;36(6):1215–8; discussion 8–9.

    Article  CAS  PubMed  Google Scholar 

  6. Feiz-Erfan I, Spetzler RF, Horn EM, Porter RW, Beals SP, Lettieri SC, et al. Proposed classification for the transbasal approach and its modifications. Skull Base: Off J N Am Skull Base Soc [et al.]. 2008;18(1):29–47.

    Google Scholar 

  7. Chi JH, Parsa AT, Berger MS, Kunwar S, McDermott MW. Extended bifrontal craniotomy for midline anterior fossa meningiomas: minimization of retraction-related edema and surgical outcomes. Neurosurgery. 2006;59(4 Suppl 2):ONS426–33; discussion ONS33–4.

    Google Scholar 

  8. Mayfrank L, Gilsbach JM. Interhemispheric approach for microsurgical removal of olfactory groove meningiomas. Br J Neurosurg. 1996;10(6):541–5.

    Article  CAS  PubMed  Google Scholar 

  9. Jang WY, Jung S, Jung TY, Moon KS, Kim IY. Preservation of olfaction in surgery of olfactory groove meningiomas. Clin Neurol Neurosurg. 2013;115(8):1288–92.

    Article  PubMed  Google Scholar 

  10. Zabramski JM, Kiris T, Sankhla SK, Cabiol J, Spetzler RF. Orbitozygomatic craniotomy. Technical note. J Neurosurg. 1998;89(2):336–41.

    Article  CAS  PubMed  Google Scholar 

  11. Seckin H, Avci E, Uluc K, Niemann D, Baskaya MK. The work horse of skull base surgery: orbitozygomatic approach. Technique, modifications, and applications. Neurosurg Focus. 2008;25(6):E4.

    Article  PubMed  Google Scholar 

  12. Bitter AD, Stavrinou LC, Ntoulias G, Petridis AK, Dukagjin M, Scholz M, et al. The role of the pterional approach in the surgical treatment of olfactory groove meningiomas: a 20-year experience. J Neurol Surg B Skull Base. 2013;74(2):97–102.

    Google Scholar 

  13. Chen WC, Magill ST, Englot DJ, Baal JD, Wagle S, Rick JW, et al. Factors associated with pre- and postoperative seizures in 1033 patients undergoing supratentorial meningioma resection. Neurosurgery. 2017. [Epub ahead of print].

    Google Scholar 

  14. Bakay L, Cares HL. Olfactory meningiomas. Report on a series of twenty-five cases. Acta Neurochir. 1972;26(1):1–12.

    Article  CAS  PubMed  Google Scholar 

  15. Pallini R, Fernandez E, Lauretti L, Doglietto F, D’Alessandris QG, Montano N, et al. Olfactory groove meningioma: report of 99 cases surgically treated at the Catholic University School of Medicine, Rome. World Neurosurg. 2015;83(2):219–31 e1–3.

    Article  PubMed  Google Scholar 

  16. Hentschel SJ, DeMonte F. Olfactory groove meningiomas. Neurosurg Focus. 2003;14(6):e4.

    Article  PubMed  Google Scholar 

  17. Aguiar PH, Tahara A, Almeida AN, Simm R, Silva AN, Maldaun MV, et al. Olfactory groove meningiomas: approaches and complications. J Clin Neurosci Off J Neurosurg Soc Aust. 2009;16(9):1168–73.

    Google Scholar 

  18. Nakamura M, Struck M, Roser F, Vorkapic P, Samii M. Olfactory groove meningiomas: clinical outcome and recurrence rates after tumor removal through the frontolateral and bifrontal approach. Neurosurgery. 2007;60(5):844–52; discussion -52.

    Article  PubMed  Google Scholar 

  19. Nanda A, Maiti TK, Bir SC, Konar SK, Guthikonda B. Olfactory groove meningiomas: comparison of extent of frontal lobe changes after lateral and bifrontal approaches. World Neurosurg. 2016;94:211–21.

    Google Scholar 

  20. Tomasello F, Angileri FF, Grasso G, Granata F, De Ponte FS, Alafaci C. Giant olfactory groove meningiomas: extent of frontal lobes damage and long-term outcome after the pterional approach. World Neurosurg. 2011;76(3–4):311–7; discussion 255–8.

    Google Scholar 

  21. Obeid F, Al-Mefty O. Recurrence of olfactory groove meningiomas. Neurosurgery. 2003;53(3):534–42; discussion 42–3.

    Article  PubMed  Google Scholar 

  22. Spektor S, Valarezo J, Fliss DM, Gil Z, Cohen J, Goldman J, et al. Olfactory groove meningiomas from neurosurgical and ear, nose, and throat perspectives: approaches, techniques, and outcomes. Neurosurgery. 2005;57(4 Suppl):268–80; discussion -80.

    PubMed  Google Scholar 

  23. Fries G, Perneczky A. Endoscope-assisted brain surgery: part 2 – analysis of 380 procedures. Neurosurgery. 1998;42(2):226–31; discussion 231–2.

    Article  CAS  PubMed  Google Scholar 

  24. Perneczky A, Fries G. Endoscope-assisted brain surgery: part 1 – evolution, basic concept, and current technique. Neurosurgery, 1998;42(2):219–24; discussion 224–5.

    Google Scholar 

  25. Reisch R, Perneczky A. Ten-year experience with the supraorbital subfrontal approach through an eyebrow skin incision. Neurosurgery. 2005;57(4 Suppl):242–55; discussion 242–55.

    Google Scholar 

  26. Schroeder HW, Oertel J, Gaab MR. Endoscope-assisted microsurgical resection of epidermoid tumors of the cerebellopontine angle. J Neurosurg. 2004;101(2):227–32.

    Article  PubMed  Google Scholar 

  27. Schwartz TH. An eyebrow for an eyebrow and a nose for a nose. World Neurosurg. 2014;82(1–2):e97–9.

    Google Scholar 

  28. Wilson DA, et al. The supraorbital endoscopic approach for tumors. World Neurosurg. 2014;82(6 Suppl):S72–80.

    Google Scholar 

  29. Koppe M, et al. Superior eyelid crease approach for transobital neuroendoscopic surgery of the anterior cranial fossa. J Craniofac Surg. 2013;24(5):1616–21.

    Article  PubMed  Google Scholar 

  30. Raza SM, et al. The supraorbital craniotomy for access to the skull base and intraaxial lesions: a technique in evolution. Minim Invasive Neurosurg. 2010;53(1):1–8.

    Article  CAS  PubMed  Google Scholar 

  31. Igressa A, et al. Endoscope-assisted keyhole surgery via an eyebrow incision for removal of large meningiomas of the anterior and middle cranial fossa. Clin Neurol Neurosurg. 2015;129:27–33.

    Article  PubMed  Google Scholar 

  32. Jho HD. Orbital roof craniotomy via an eyebrow incision: a simplified anterior skull base approach. Minim Invasive Neurosurg. 1997;40(3):91–7.

    Article  CAS  PubMed  Google Scholar 

  33. Bassiouni H, Asgari S, Stolke D. Olfactory groove meningiomas: functional outcome in a series treated microsurgically. Acta Neurochir (Wien). 2007;149(2):109–21; discussion 121.

    Article  CAS  Google Scholar 

  34. Telera S, et al. Supraorbital keyhole approach for removal of midline anterior cranial fossa meningiomas: a series of 20 consecutive cases. Neurosurg Rev. 2012;35(1):67–83; discussion 83.

    Article  PubMed  Google Scholar 

  35. Romani R, et al. Lateral supraorbital approach applied to olfactory groove meningiomas: experience with 66 consecutive patients. Neurosurgery. 2009;65(1):39–52; discussion 52–3.

    Article  PubMed  Google Scholar 

  36. Banu MA, et al. Endoscope-assisted endonasal versus supraorbital keyhole resection of olfactory groove meningiomas: comparison and combination of 2 minimally invasive approaches. J Neurosurg. 2016;124(3):605–20.

    Google Scholar 

  37. Schroeder HW, Hickmann AK, Baldauf J. Endoscope-assisted microsurgical resection of skull base meningiomas. Neurosurg Rev. 2011;34(4):441–55.

    Article  PubMed  Google Scholar 

  38. Kabil MS, Shahinian HK. Application of the supraorbital endoscopic approach to tumors of the anterior cranial base. J Craniofac Surg. 2005;16(6):1070–4; discussion 1075.

    Article  PubMed  Google Scholar 

  39. Schroeder HW. Indications and limitations of the endoscopic endonasal approach for anterior cranial base meningiomas. World Neurosurg. 2014;82(6 Suppl):S81–5.

    Article  PubMed  Google Scholar 

  40. Schwartz TH. Editorial: should endoscopic endonasal surgery be used in the treatment of olfactory groove meningiomas? Neurosurg Focus. 2014;37:E9–15.

    Google Scholar 

  41. Komotar RJ, Starke RM, Raper DMS, Anand VK, Schwartz TH. Endoscopic endonasal versus open transcranial resection of anterior midline skull base meningiomas. WNEU. 2012;77:713–24.

    Google Scholar 

  42. Banu MA, Mehta A, Ottenhausen M, Fraser JF, Patel KS, Szentirmai O, et al. Endoscope-assisted endonasal versus supraorbital keyhole resection of olfactory groove meningiomas: comparison and combination of 2 minimally invasive approaches. J Neurosurg. 2016;124:605–20.

    Article  PubMed  Google Scholar 

  43. Marco A, Mascarella MD, Marc A, Tewfik MMF, Majed Aldosari MM, Denis Sirhan MF, Anthony Zeitouni MMF, Salvatore Di Maio MF. A simple scoring system to predict the resectability of skull base meningiomas via an endoscopic endonasal approach. WNEU 2016;91:582–591.

    Google Scholar 

  44. Simpson D. The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry. 1957;20:22–39.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Gousias K, Schramm J, Simon M. The Simpson grading revisited: aggressive surgery and its place in modern meningioma management. J Neurosurg. 2016;125:551–60.

    Article  PubMed  Google Scholar 

  46. Cappabianca P, Cavallo LM, Esposito F, de Divitiis O, Messina A, de Divitiis E. Extended endoscopic endonasal approach to the midline skull base: the evolving role of transsphenoidal surgery. Adv Tech Stand Neurosurg. 2008;33:151–99.

    Google Scholar 

  47. de Divitiis E, Cavallo LM, Cappabianca P, Esposito F. Extended endoscopic endonasal transsphenoidal approach for the removal of suprasellar tumors. Neurosurgery. 2007;60(46):59–14.

    Google Scholar 

  48. Cavallo LM, de Divitiis O, Aydin S, Messina A, Esposito F, Iaconetta G, et al. Extended endoscopic endonasal transsphenoidal approach to the suprasellar area: anatomic considerations – part 1. Neurosurgery. 2008;62:1202–12.

    Google Scholar 

  49. Ceylan S, Koc K, Anik I. Extended endoscopic approaches for midline skull-base lesions. Neurosurg Rev. 2009;32:309–19.

    Article  PubMed  Google Scholar 

  50. Kassam A, Snyderman CH, Mintz A, Gardner P, Carrau RL. Expanded endonasal approach: the rostrocaudal axis. Part I. Crista galli to the sella turcica. Neurosurg Focus. 2005;19:E3.

    Google Scholar 

  51. Dehdashti AR, Karabatsou K, Ganna A, Witterick I, Gentili F. Expanded endoscopic endonasal approach for treatment of clival chordomas: early results in 12 patients. Neurosurgery. 2008;63:299–307. Discussion 307–9.

    Article  PubMed  Google Scholar 

  52. Dehdashti AR, Ganna A, Witterick I, Gentili F. Expanded endoscopic endonasal approach for anterior cranial base and suprasellar lesions. Neurosurgery. 2009;64:677–89.

    Article  PubMed  Google Scholar 

  53. Gardner PA, Kassam AB, Thomas A, Snyderman CH, Carrau RL, Mintz AH, et al. Endoscopic endonasal resection of anterior cranial base meningiomas. Neurosurgery. 2008;63:36–54.

    Article  PubMed  Google Scholar 

  54. Kshettry VR, Elshazly K, Evans JJ. Endoscopic transnasal surgery for planum and tuberculum sella meningiomas: decision-making, technique and outcomes. CNS Oncol. 2016;5:211–22.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. Liu JK, Hattar E, Eloy JA. Endoscopic endonasal approach for olfactory groove meningiomas. Neurosurg Clin NA. 2015;26:377–88.

    Article  Google Scholar 

  56. Liu JK, Christiano LD, Patel SK, Tubbs RS, Eloy JA. Surgical nuances for removal of olfactory groove meningiomas using the endoscopic endonasal transcribriform approach. Neurosurg Focus. 2011;30:E3.

    Article  PubMed  Google Scholar 

  57. Koutourousiou M, Fernandez-Miranda JC, Wang EW, Snyderman CH, Gardner PA. Endoscopic endonasal surgery for olfactory groove meningiomas: outcomes and limitations in 50 patients. Neurosurg Focus. 2014;37:E8–2.

    Article  PubMed  Google Scholar 

  58. Hadad G, Bassagasteguy L, Carrau RL, Mataza JC, Kassam A, Snyderman CH, et al. A novel reconstructive technique after endoscopic expanded endonasal approaches: vascular pedicle nasoseptal flap. Laryngoscope. 2006;116:1882–6.

    Article  PubMed  Google Scholar 

  59. Kassam AB, Thomas A, Carrau RL, Snyderman CH, Vescan A, Prevedello D, et al. Endoscopic reconstruction of the cranial base using a pedicled nasoseptal flap. Neurosurgery. 2008;63:ONS44–52. Discussion ONS52–3.

    PubMed  Google Scholar 

  60. Zanation AM, Carrau RL, Snyderman CH, Germanwala AV, Gardner PA, Prevedello DM, et al. Nasoseptal flap reconstruction of high flow intraoperative cerebral spinal fluid leaks during endoscopic skull base surgery. Am J Rhinol Allergy. 2009;23:518–21.

    Article  PubMed  Google Scholar 

  61. Youssef AS, Sampath R, Freeman JL, Mattingly JK, Ramakrishnan VR. Unilateral endonasal transcribriform approach with septal transposition for olfactory groove meningioma: can olfaction be preserved? Acta Neurochirurgica 2016;158(10):1965–72.

    Google Scholar 

  62. Rosen MR, Rabinowitz MR, Farrell CJ, Schaberg MR, Evans JJ. Septal transposition: a novel technique for preservation of the nasal septum during endoscopic endonasal resection of olfactory groove meningiomas. Neurosurg Focus. 2014;37:E6.

    Article  PubMed  Google Scholar 

  63. Lund VJ, Stammberger H, Nicolai P, Castelnuovo P, Beal T, Beham A, et al. European position paper on endoscopic management of tumors of the nose, paranasal sinuses and skull base. Rhinology Suppl. 2010;22:1–143.

    Google Scholar 

  64. Fishpool SJC, Amato-Watkins A, Hayhurst C. Free middle turbinate mucosal graft reconstruction after primary endoscopic endonasal pituitary surgery. Eur Arch Otorhinolaryngol. 2017;274(2):837–844.

    Google Scholar 

  65. Battaglia P, Turri-Zanoni M, De Bernardi F, Dehgani Mobaraki P, Karligkiotis A, Leone F, et al. Septal flip flap for anterior skull base reconstruction after endoscopic resection of sinonasal cancers: preliminary outcomes. Acta Otorhinolaryngol Ital. 2016;36:194–8.

    CAS  PubMed  PubMed Central  Google Scholar 

  66. Georgalas C, Badloe R, van Furth W, Reinartz S, Fokkens WJ. Quality of life in extended endonasal approaches for skull base tumors. Rhinology. 2012;50:255–61.

    Article  CAS  PubMed  Google Scholar 

  67. Alobid I, Ensenat J, Marino-Sanchez F, de Notaris M, Centellas S, Mullol J, et al. Impairment of olfaction and mucociliary clearance after expanded endonasal approach using vascularized septal flap reconstruction for skull base tumors. Neurosurgery. 2013;72:540–6.

    Article  PubMed  Google Scholar 

  68. Psaltis AJ, Schlosser RJ, Banks CA, Yawn J, Soler ZM. A systematic review of the endoscopic repair of cerebrospinal fluid leaks. Otolaryngol Head Neck Surg. 2012;147:196–203.

    Article  PubMed  Google Scholar 

  69. Khan OH, Anand VK, Schwartz TH. Endoscopic endonasal resection of skull base meningiomas: the significance of a “cortical cuff” and brain edema compared with careful case selection and surgical experience in predicting morbidity and extent of resection. Neurosurg Focus. 2014;37:E7.

    PubMed  Google Scholar 

  70. Gellner V, Koele W, Wolf A, Gerstenberger C, Mokry M, Stammberger H, et al. A piezoelectric device for bone work in endoscopic anterior skull base surgery – a feasibility study in 15 patients. Clin Otolaryngol. 2017 Aug;42(4):927–931.

    Google Scholar 

  71. Alobid I, Ensenat J, Marino-Sanchez F, Rioja E, de Notaris M, Mullol J, et al. Expanded endonasal approach using vascularized septal flap reconstruction for skull base tumors has a negative impact on sinonasal symptoms and quality of life. Am J Rhinol Allergy. 2013;27:426–31.

    Article  PubMed  Google Scholar 

  72. de Almeida JR, Carvalho F, Vaz Guimaraes Filho F, Kiehl T-R, Koutourousiou M, Su S, et al. Comparison of endoscopic endonasal and bifrontal craniotomy approaches for olfactory groove meningiomas: a matched pair analysis of outcomes and frontal lobe changes on MRI. J Clin Neurosci Off J Neurosurg Soc Australas. 2015 Nov;22(11):1733–41.

    Google Scholar 

  73. Komotar RJ, Starke RM, Raper DMS, Anand VK, Schwartz TH. Endoscopic endonasal versus open transcranial resection of anterior midline skull base meningiomas. World Neurosurg. 2012 Jun;77(5–6):713–24.

    Article  PubMed  Google Scholar 

Download references

Author information

Author notes

  1. *Invited senior authors. See chapter subsection for complete list of authors.

Authors and Affiliations

  1. Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, USA

    Michael W. McDermott

  2. Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany

    Henry W. S. Schroeder

  3. Department of Neurosurgery, Medical University Graz, Graz, Austria

    Verena Gellner

Authors
  1. Michael W. McDermott
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Henry W. S. Schroeder
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Verena Gellner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael W. McDermott .

Editor information

Editors and Affiliations

  1. Cranial Base and Pituitary Surgery Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA

    James J. Evans

  2. Pituitary and Cranial Base Surgery, Department of Neurosurgery, Albany Medical Center, Albany, NY, USA

    Tyler J. Kenning

  3. Cranial Base and Pituitary Surgery Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA, USA

    Christopher Farrell

  4. Skull Base, Pituitary and Cerebrovascular Surgery Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, USA

    Varun R. Kshettry

Rights and permissions

Reprints and permissions

Copyright information

© 2019 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

McDermott, M.W., Schroeder, H.W.S., Gellner, V. (2019). 16 Olfactory Groove Meningiomas. In: Evans, J., Kenning, T., Farrell, C., Kshettry, V. (eds) Endoscopic and Keyhole Cranial Base Surgery . Springer, Cham. https://doi.org/10.1007/978-3-319-64379-3_16

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-64379-3_16

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-64378-6

  • Online ISBN: 978-3-319-64379-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation