Resection of olfactory groove meningiomas: technical note revisited.

BACKGROUND: Although large olfactory groove meningiomas present in the midline, tumor volume is often unequally distributed to one side. Most surgeons favor a bifrontal craniotomy with retraction or partial resection of the frontal lobes to resect these tumors. However, frontal lobe retraction is not without complications.
METHODS: We present a technical note regarding the resection of these large olfactory groove meningiomas. We describe the advantages of a unilateral frontal craniotomy complemented with orbital osteotomy.
RESULTS: The orbital osteotomy has considerably reduced the need for frontal lobe retraction and avoids partial resection of the frontal lobe to uncap the tumor. Utilizing this approach we have been able to remove the tumor from one side, followed by an incision to the falx cerebri in order to remove the tumor from the other side. With this approach, we have gained excellent visualization of the tumor in its entirety. Moreover, this approach permits the surgeon to intercept the arteries emerging from the skull base during the initial stages of the procedure.
CONCLUSIONS: Unilateral frontal craniotomy and orbital osteotomy has obviated the need to retract or resect the frontal lobe when resecting large olfactory groove meningiomas, which extend to either side of the falx. Because surgery is performed from one side, olfaction may also be preserved on the contralateral side.