Unilateral Endonasal Transcribriform Approach with Septal Transposition for Olfactory Groove Meningioma: Can Olfaction Be Preserved?

Background: Loss of olfaction has been considered inevitable in endoscopic endonasal resection of olfactory groove meningiomas. The concept of olfaction preservation may be feasible through an endonasal unilateral transcribriform approach with septal transposition and contralateral preservation of the olfactory apparatus.

Methods: An expanded unilateral endonasal transcribriform approach with septal transposition was performed in five cadaveric heads. The approach was applied in a surgical case of a 24 × 26 mm olfactory groove meningioma originating from one cribriform plate with partially intact olfaction.

Results: The surgical approach offered adequate exposure to the anterior skull base bilaterally. The nasal/septal mucosa was preserved on the contralateral side. Gross total resection of a small meningioma was achieved with the successful preservation of the contralateral olfactory apparatus and preoperative olfaction. Six months later, the left nasal cavity showed no disruption of the mucosal lining and the right side was at the appropriate stage of healing for a harvested nasal septal flap. One year later, the preoperative olfactory function was intact and favorably viewed by the patient. Objective testing of olfaction showed microsomia.

Conclusion: The concept of olfaction preservation may be feasible in the endoscopic endonasal resection of a unilateral olfactory groove meningioma through a unilateral transcribriform approach with septal transposition and preservation of the contralateral olfactory apparatus.