Recovery of olfactory function after an anterior craniofacial approach.

We assessed recovery of olfactory function in five consecutive patients who underwent surgical resection of midline skull base tumors using an anterior craniofacial approach in which the cribriform plate was mobilized with the dura. Olfactory function was evaluated before and after surgery using an intravenous olfactory test with prosultiamine and also a standard olfactory acuity test. Before surgery, one patient showed anosmia attributable to obstruction of the nasal cavity and olfactory cleft, and four patients showed normal olfactory function. After surgery, one patient was irreversibly anosmic, probably because of intradural dissection of the olfactory tracts. The other four patients, including the patient showing anosmia preoperatively, reported subjective recovery of olfaction 3 to 8 weeks after surgery. Intravenous and standard olfactory acuity tests indicated recovery of olfaction to the normal range in three patients and decreased olfactory function in one. With careful preservation of the olfactory system and of the integrity of the nasal cavity, olfactory function was found to recover after skull base resections via the anterior craniofacial approach.