OBJECTIVE Management of olfactory groove meningiomas (OGMs) has changed significantly with the advances in extended endoscopic endonasal approaches (EEAs), which is an excellent approach for patients with anosmia since it allows early devascularization and minimizes retraction on the frontal lobes. Craniotomy is best suited for preservation of olfaction. However, not infrequently, a tumor presents after extending outside the reach of an EEA and a solely transcranial approach would require manipulation and retraction of the frontal lobes. These OGMs may best be treated by a staged EEA-craniotomy approach. In this study the authors' goal was to present their case series of patients with OGMs treated with their surgical approach algorithm. METHODS The authors conducted an IRB-approved, nonrandomized historic cohort including all consecutive cases of OGMs treated surgically between 2010 and 2020. Patient demographic information, presenting symptoms, operative details, and complications data were collected. Preoperative and postoperative tumor and T2/FLAIR intensity volumes were calculated using Visage Imaging software. RESULTS Thirty-one patients with OGMs were treated (14 craniotomy only, 11 EEA only, and 6 staged). There was a significant difference in the distribution of patients presenting with anosmia and visual disturbance by approach. Tumor size was significantly correlated with preoperative vasogenic edema. Gross-total resection was achieved in 90% of cases, with near-total resection occurring twice with EEA and once with a staged approach. T2/FLAIR hyperintensity completely resolved in 90% of cases and rates did not differ by approach. Complication rates were not significantly different by approach and included 4 CSF leaks (p = 0.68). CONCLUSIONS A staged approach for the management of large OGMs with associated anosmia and significant lateral extension is a safe and effective option for surgical management. Through utilization of the described algorithm, the authors achieved a high rate of GTR, and this strategy may be considered for large OGMs.

中文翻译：

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嗅沟脑膜瘤的现代治疗方法。

目的 随着扩展内镜鼻内入路 (EEA) 的进步，嗅沟脑膜瘤 (OGM) 的治疗发生了显着变化，对于嗅觉丧失患者来说，这是一种极好的方法，因为它允许早期断流并最大限度地减少额叶的回缩。开颅手术最适合保留嗅觉。然而，肿瘤在延伸到 EEA 范围之外后出现的情况并不少见，单纯的经颅入路需要操作和牵拉额叶。这些 OGM 的最佳治疗方法可能是分阶段 EEA 开颅手术。在这项研究中，作者的目标是展示使用他们的手术方法算法治疗的 OGM 患者的病例系列。方法 作者进行了一项经 IRB 批准的非随机历史队列研究，其中包括 2010 年至 2020 年期间接受手术治疗的所有连续 OGM 病例。收集了患者人口统计信息、表现症状、手术细节和并发症数据。使用 Visage Imaging 软件计算术前和术后肿瘤和 T2/FLAIR 强度体积。结果 31 例 OGM 患者接受治疗（14 例仅开颅手术，11 例仅 EEA，6 例分期）。就诊而言，出现嗅觉丧失和视力障碍的患者分布存在显着差异。肿瘤大小与术前血管源性水肿显着相关。90% 的病例实现了大体全切除，其中两次采用 EEA 进行近全切除，一次采用分期手术。90% 的病例中 T2/FLAIR 高信号完全缓解，并且不同方法的缓解率没有差异。不同方法的并发症发生率没有显着差异，包括 4 例脑脊液漏（p = 0.68）。结论 对于伴有嗅觉丧失和显着侧向伸展的大型 OGM 的分阶段治疗方法是一种安全有效的手术治疗选择。通过利用所描述的算法，作者实现了较高的 GTR 率，并且该策略可以考虑用于大型 OGM。