Lina Raffaella Barzaghi1, Alfio Spina2, Filippo Gagliardi1, Nicola Boari1, Pietro Mortini1. 1. Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy. 2. Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy. Electronic address: spina.alfio@hsr.it.
Abstract
BACKGROUND: The transfrontal-sinus-subcranial approach (TFSSA) allows for direct exposure and removal of olfactory groove meningiomas (OGMs), without any brain retraction. Compared with other skull base approaches (e.g., fronto-orbitobasal, transbasal, subcranial, fronto-orbitozygomatic, and one-and-half approach), it could offer the same advantages but is less invasive. OBJECTIVE: We report the results in a series of 21 consecutive patients with OGMs and operated on through TFSSA, to propose a viable alternative approach. METHODS: Mean maximum tumor diameter was 45.9 ± 3.4 mm (range, 25-70 mm). The aim of surgery was Simpson grade I removal. Surgical, clinical, and functional outcomes were reported. Mean follow-up was 87 ± 7 months (range, 36-176 months). RESULTS: In all patients, magnetic resonance imaging after surgery confirmed complete tumor removal. The recurrence-free survival rate was 100% and 85.7% at 5 and 10 years, respectively. Surgery-related mortality and major morbidity were 0% and 4.8%, respectively. Risk of anosmia significantly correlates with meningioma size (P < 0.001) and smell sense was preserved only in patients with tumors less than 4 cm in maximum diameter (4/7; 57.1%). A significant improvement of Mini Mental Standard Examination score was recorded at follow-up (P < 0.001) and no patients worsened their cognitive profile. Visual function improved in 7/8 (87.5%). Karnofsky Performance Scale score after surgery significantly increased (P < 0.001). According to the Glasgow Outcome Score, good outcome was achieved in 20 patients (95.2%). CONCLUSIONS: Based on reported results, TFSSA allows complete tumor removal with good outcome and low complication rate. It may be proposed as a safe and effective approach to treat large and giant OGMs.
BACKGROUND: The transfrontal-sinus-subcranial approach (TFSSA) allows for direct exposure and removal of olfactory groove meningiomas (OGMs), without any brain retraction. Compared with other skull base approaches (e.g., fronto-orbitobasal, transbasal, subcranial, fronto-orbitozygomatic, and one-and-half approach), it could offer the same advantages but is less invasive. OBJECTIVE: We report the results in a series of 21 consecutive patients with OGMs and operated on through TFSSA, to propose a viable alternative approach. METHODS: Mean maximum tumor diameter was 45.9 ± 3.4 mm (range, 25-70 mm). The aim of surgery was Simpson grade I removal. Surgical, clinical, and functional outcomes were reported. Mean follow-up was 87 ± 7 months (range, 36-176 months). RESULTS: In all patients, magnetic resonance imaging after surgery confirmed complete tumor removal. The recurrence-free survival rate was 100% and 85.7% at 5 and 10 years, respectively. Surgery-related mortality and major morbidity were 0% and 4.8%, respectively. Risk of anosmia significantly correlates with meningioma size (P < 0.001) and smell sense was preserved only in patients with tumors less than 4 cm in maximum diameter (4/7; 57.1%). A significant improvement of Mini Mental Standard Examination score was recorded at follow-up (P < 0.001) and no patients worsened their cognitive profile. Visual function improved in 7/8 (87.5%). Karnofsky Performance Scale score after surgery significantly increased (P < 0.001). According to the Glasgow Outcome Score, good outcome was achieved in 20 patients (95.2%). CONCLUSIONS: Based on reported results, TFSSA allows complete tumor removal with good outcome and low complication rate. It may be proposed as a safe and effective approach to treat large and giant OGMs.
Authors: Danyal Z Khan; Ivo S Muskens; Rania A Mekary; Amir H Zamanipoor Najafabadi; Adel E Helmy; Robert Reisch; Marike L D Broekman; Hani J Marcus Journal: Acta Neurochir (Wien) Date: 2020-09-05 Impact factor: 2.216
Authors: Austin Y Feng; Sandy Wong; Sabir Saluja; Michael C Jin; Anthony Thai; Arjun V Pendharkar; Allen L Ho; Prasad Reddy; Allen D Efron Journal: Front Oncol Date: 2020-10-22 Impact factor: 6.244