En bloc removal of large bilateral olfactory groove meningioma.

With careful pre-operative angiographic evaluation, reversible intra-operative external carotid occlusion, controlled hypotension, steroids, osmotic diuretics, and early control of nutrient arteries, the en bloc removal of a large bilateral olfactory groove meningioma is feasible in some instances. Dissection around the tumor is facilitated by shrinkage of the tumor, as its nutrient vessels are occluded. Ligation and division of the venous drainage is left until the end. This technique may be particularly valuable in poor risk patients, as it may considerably reduce blood loss and operating time, without sacrifice of brain.