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Eyebrow supraorbital keyhole craniotomy for olfactory groove meningiomas with endoscope assistance: case series and systematic review of extent of resection, quantification of postoperative frontal lobe injury, anosmia, and recurrence

  • Original Article - Brain Tumors
  • Published:
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Abstract

Background

Olfactory groove meningiomas (OGMs) are commonly treated with open craniotomy. Endonasal approaches have also been described.

Objective

To present clinical and radiographic outcomes for the minimally invasive eyebrow incision supraorbital keyhole approach with endoscopic assistance for OGMs.

Methods

We performed a retrospective single-center cohort study and a systematic literature review.

Results

Fifteen patients were identified, all with Grade I meningiomas. Radiographic gross total resection of enhancing tumor was achieved in all patients. Mean frontal lobe fluid-attenuated inversion recovery volume decreased from 11.1 ± 18.3 cm3 preoperatively to 9.9 ± 11.4 cm3 immediately postoperatively, and there was minimal new restricted diffusion (3.2 ± 2.2 cm3; max 7.5 cm3). Median length of stay was 3 days (range 2–8). Vision was improved in 4 (80%) and stable in 1 (20%) of 5 patients with a preoperative deficit. New postoperative anosmia occurred in 3 (23%) of 13 patients with any preoperative olfaction. All patients were satisfied with their cosmetic result at 3 months. After a median follow-up of 32.2 months, there were 2 (13.3%) asymptomatic radiographic recurrences, 1 treated with radiosurgery and the other with endoscopic endonasal approach (EEA). No patients required further craniotomy. Systematic review revealed the present series to be the largest to date reporting disaggregated outcomes for the eyebrow approach to OGM.

Conclusion

The eyebrow incision supraorbital keyhole craniotomy with endoscopic assistance is a safe and effective approach to OGM with tumor control rates similar to more invasive open approaches and better than the endonasal approach. Rates of frontal lobe injury, CSF leak and anosmia are comparatively low.

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Authors and Affiliations

  1. Department of Neurosurgery, Weill Cornell Medicine, New York-Presbyterian Hospital, 525 East 68th St., Box #99, New York, NY, 10065, USA

    Brett E. Youngerman, Lior Shtayer, Mina M. Gerges, Alexandra G. Larsen, Hilarie C. Tomasiewicz & Theodore H. Schwartz

  2. Department of Neurosurgery, Columbia University Medical Center, New York-Presbyterian Hospital, New York, NY, USA

    Brett E. Youngerman

  3. Department of Neurosurgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt

    Mina M. Gerges

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  1. Brett E. Youngerman
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Correspondence to Theodore H. Schwartz.

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All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee (Weill Cornell Medicine Institutional Review Board) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study formal consent is not required.

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Youngerman, B.E., Shtayer, L., Gerges, M.M. et al. Eyebrow supraorbital keyhole craniotomy for olfactory groove meningiomas with endoscope assistance: case series and systematic review of extent of resection, quantification of postoperative frontal lobe injury, anosmia, and recurrence. Acta Neurochir 163, 101–112 (2021). https://doi.org/10.1007/s00701-020-04552-x

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