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Limitations of the endonasal endoscopic approach in treating olfactory groove meningiomas. A systematic review

  • Review Article - Brain Tumors
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Abstract

Objective

To review current management strategies for olfactory groove meningioma (OGM)s and the recent literature comparing endoscopic endonasal (EEA) with traditional transcranial (TCA) approaches.

Methods

A PubMed search of the recent literature (2011–2016) was performed to examine outcomes following EEA and TCA for OGM. The extent of resection, visual outcome, postoperative complications and recurrence rates were analyzed using percentages and proportions, the Fischer exact test and the Student’s t-test using Graphpad PRISM 7.0Aa (San Diego, CA) software.

Results

There were 444 patients in the TCA group with a mean diameter of 4.61 (±1.17) cm and 101 patients in the EEA group with a mean diameter of 3.55 (± 0.58) cm (p = 0.0589). GTR was achieved in 90.9% (404/444) in the TCA group and 70.2% (71/101) in the EEA group (p < 0.0001). Of the patients with preoperative visual disturbances, 80.7% (21/26) of patients in the EEA cohort had an improvement in vision compared to 12.83%(29/226) in the TCA group (p < 0.0001). Olfaction was lost in 61% of TCA and in 100% of EEA patients. CSF leaks and meningitis occurred in 25.7% and 4.95% of EEA patients and 6.3% and 1.12% of TCA patients, respectively (p < 0.0001; p = 0.023).

Conclusions

Our updated literature review demonstrates that despite more experience with endoscopic resection and skull base reconstruction, the literature still supports TCA over EEA with respect to the extent of resection and complications. EEA may be an option in selected cases where visual improvement is the main goal of surgery and postoperative anosmia is acceptable to the patient or in medium-sized tumors with existing preoperative anosmia. Nevertheless, based on our results, it seems more prudent at this time to use TCA for the majority of OGMs.

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Funding

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Authors and Affiliations

  1. Department of Neurosurgery, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA

    Sathwik Raviraj Shetty, Armando S. Ruiz-Treviño, Sacit Bulent Omay, Joao Paulo Almeida, Buqing Liang, Yu-Ning Chen & Theodore H. Schwartz

  2. Department of Otolaryngology, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA

    Theodore H. Schwartz

  3. Department of Neuroscience, New York Presbyterian Hospital, Weill Cornell Medical College, New York, NY, USA

    Theodore H. Schwartz

  4. Department of Neurosurgery, Stanford Hospital, Stanford, CA, USA

    Harminder Singh

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  1. Sathwik Raviraj Shetty
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  2. Armando S. Ruiz-Treviño
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  4. Joao Paulo Almeida
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  8. Theodore H. Schwartz
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Correspondence to Theodore H. Schwartz.

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Comments

The authors performed a systematic review of the recent literature to compare the transcranial approach to endoscopic endonasal approach for resection of olfactory groove meningiomas. The first thing to mention is clearly clarifying what an OGM is. So a tuberculum sella or planum sphenoidale meningioma with a higher risk of visual pathway compression is theoretically excluded. As has been shown previously, in this particular subset (OGMs compared to tuberculum sella meningiomas), there is not much benefit from the endonasal approach. The minimally invasive transcranial approaches [whether fronto-lateral or lateral supraorbital (LSO) craniotomies] are clearly better choices with fewer complications regarding CSF leaks and much better resection rates. The fate of visual improvement, albeit not confirmed by the literature in this study, is dependent on minute microsurgical dissection of the tumor from the visual apparatus. However, many patients with true OGMs who are possible candidates for endonasal approaches (in terms of size and extension) are not symptomatic for visual pathway compression, or, if having larger tumors, are therefore not suitable candidates for an endonasal approach. So the argument for visual improvement via an endonasal technique becomes irrelevant. The olfactory groove is a lost territory for the endonasal approach, and although I am an advocate for expanded endonasal techniques, I feel the endonasal approach is not an appropriate choice for true OGMs.

Amir Dehdashti

NY, USA

Institutional review board (IRB) number: 6060088601

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Shetty, S.R., Ruiz-Treviño, A.S., Omay, S.B. et al. Limitations of the endonasal endoscopic approach in treating olfactory groove meningiomas. A systematic review. Acta Neurochir 159, 1875–1885 (2017). https://doi.org/10.1007/s00701-017-3303-0

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