Subscribe to RSS
Olfactory Outcomes after Resection of Tuberculum Sella and Planum Sphenoidale Meningiomas via a Transcranial ApproachFunding None.
Objectives Controversy exists surrounding the optimal approaches to tuberculum sella meningioma (TSM) and planum meningioma (PM). Olfaction is infrequently considered within this context but is nonetheless an important quality of life measure. The evolution of olfactory outcomes following contemporary transcranial surgery remains unclear. This study reviews olfactory outcomes after supraorbital craniotomy for TSM or PM and defines temporal trends in its recovery.
Study Design A prospective study of a patients who underwent a minimally invasive supraorbital craniotomy for TSM or PM was conducted at a single neurosurgical center.
Participants & Main Outcome Measures All patients were questioned about olfaction at presentation 3 months postoperatively, 12 months postoperatively, and annually thereafter (median follow-up = 37 months). The olfactory status of patients was categorized as normosmia, anosmia, hyposmia, parosmia, (altered perception of odours), or phantosmia, (olfactory hallucinations).
Results Twenty-two patients were included in the study analysis, (range = 27–76). Precisely, 3 months after surgery, seven patients had normal olfaction (32%). Six patients were anosmic, (27%) four hyposmic, (18%), three parosmic, (14%), and two were phantosmic (9%). At 1-year follow-up, almost half of patients (10; 48%) were normosmic, while two patients (9.5%) were anosmic. There were no further improvements in olfaction between 1 year and long-term follow-up.
Conclusion Subfrontal transcranial approaches for TSM or PM appear to be associated with changes in olfaction that can improve with time; these improvements occur within the first year after surgery. Impacts upon olfaction should be considered when selecting a surgical approach and patients counseled appropriately.
The study was presented at the British Skull Base Society Meeting, (Poster) January 2020, London. This study was performed in accordance with the ethical standards of the Cardiff and Vale University Health Board Neurosciences directorate research and audit department, and with the 1964 Helsinki Declaration and its later amendments.
Informed consent was obtained from all individual participants included in the study.
Received: 29 July 2020
Accepted: 01 November 2020
Article published online:
21 January 2021
© 2021. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
- 1 Browne JD, Mims JW. Preservation of olfaction in anterior skull base surgery. Laryngoscope 2000; 110 (08) 1317-1322
- 2 Soni RS, Patel SK, Husain Q, Dahodwala MQ, Eloy JA, Liu JK. From above or below: the controversy and historical evolution of tuberculum sellae meningioma resection from open to endoscopic skull base approaches. J Clin Neurosci 2014; 21 (04) 559-568
- 3 Bander ED, Singh H, Ogilvie CB. et al. Endoscopic endonasal versus transcranial approach to tuberculum sellae and planum sphenoidale meningiomas in a similar cohort of patients. J Neurosurg 2018; 128 (01) 40-48
- 4 Banu MA, Mehta A, Ottenhausen M. et al. Endoscope-assisted endonasal versus supraorbital keyhole resection of olfactory groove meningiomas: comparison and combination of 2 minimally invasive approaches. J Neurosurg 2016; 124 (03) 605-620
- 5 Cai M, Hou B, Luo L, Zhang B, Guo Y. Trans-eyebrow supraorbital keyhole approach to tuberculum sellae meningiomas: a series of 30 cases with long-term visual outcomes and recurrence rates. J Neurooncol 2019; 142 (03) 545-555
- 6 Muskens IS, Briceno V, Ouwehand TL. et al. The endoscopic endonasal approach is not superior to the microscopic transcranial approach for anterior skull base meningiomas-a meta-analysis. Acta Neurochir (Wien) 2018; 160 (01) 59-75
- 7 Ottenhausen M, Rumalla K, Alalade AF. et al. Decision-making algorithm for minimally invasive approaches to anterior skull base meningiomas. Neurosurg Focus 2018; 44 (04) E7
- 8 Gardner PA, Kassam AB, Thomas A. et al. Endoscopic endonasal resection of anterior cranial base meningiomas. Neurosurgery 2008; 63 (01) 36-52 , discussion 52–54
- 9 Hendrix P, Fischer G, Linnebach AC. et al. Perioperative olfactory dysfunction in patients with meningiomas of the anteromedial skull base. Clin Anat 2019; 32 (04) 524-533
- 10 Alobid I, Enseñat J, Mariño-Sánchez F. et al. Impairment of olfaction and mucociliary clearance after expanded endonasal approach using vascularized septal flap reconstruction for skull base tumors. Neurosurgery 2013; 72 (04) 540-546
- 11 Komotar RJ, Starke RM, Raper DMS, Anand VK, Schwartz TH. Endoscopic endonasal versus open transcranial resection of anterior midline skull base meningiomas. World Neurosurg 2012; 77 (5-6): 713-724
- 12 Pant H, Bhatki AM, Snyderman CH. et al. Quality of life following endonasal skull base surgery. Skull Base 2010; 20 (01) 35-40
- 13 Boesveldt S, Postma EM, Boak D. et al. Anosmia-A clinical review. Chem Senses 2017; 42 (07) 513-523
- 14 Shumer D, Kassam AB. Olfactory-specific quality of life outcomes after endoscopic sinus surgery. Physiol Behav 2008; 176 (12) 139-148
- 15 Sowerby LJ, Gross M, Broad R, Wright ED. Olfactory and sinonasal outcomes in endoscopic transsphenoidal skull-base surgery. Int Forum Allergy Rhinol 2013; 3 (03) 217-220
- 16 Venteicher AS, Kumar JI, Murphy EA, Gray ST, Holbrook EH, Curry WT. Phantosmia and dysgeusia following endoscopic transcribriform approaches to olfactory groove meningiomas. J Neurol Surg B Skull Base 2017; 78 (03) 245-250
- 17 de Carvalho ACM, Dolci RLL, Rickli JCK. et al. Evaluation of olfactory function in patients undergoing endoscopic skull base surgery with nasoseptal flap. Rev Bras Otorrinolaringol (Engl Ed) 2022; 88 (01) 15-21
- 18 Dolci RLL, Miyake MM, Tateno DA. et al. Postoperative otorhinolaryngologic complications in transnasal endoscopic surgery to access the skull base. Rev Bras Otorrinolaringol (Engl Ed) 2017; 83 (03) 349-355
- 19 Xu M, Xu J, Huang X, Chen D, Chen M, Zhong P. Small extended bifrontal approach for midline anterior skull base meningiomas: our experience with 54 consecutive patients. World Neurosurg 2019; 125: e35-e43
- 20 Engelhardt J, Namaki H, Mollier O. et al. Contralateral transcranial approach to tuberculum sellae meningiomas: long-term visual outcomes and recurrence rates. World Neurosurg 2018; 116: e1066-e1074
- 21 Moman MR, Verweij BH, Buwalda J, Rinkel GJ. Anosmia after endovascular and open surgical treatment of intracranial aneurysms. J Neurosurg 2009; 110 (03) 482-486
- 22 Mortazavi MM, Brito da Silva H, Ferreira Jr M, Barber JK, Pridgeon JS, Sekhar LN. Planum sphenoidale and tuberculum sellae meningiomas: operative nuances of a modern surgical technique with outcome and proposal of a new classification system. World Neurosurg 2016; 86: 270-286
- 23 Ormond R, Hadjipanayis C. The supraorbital keyhole craniotomy through an eyebrow incision: its origins and evolution. Neuroendoscopy 2013; 1-11
- 24 Reisch R, Perneczky A, Filippi R. Surgical technique of the supraorbital key-hole craniotomy. Surg Neurol 2003; 59 (03) 223-227
- 25 Shetty SR, Ruiz-Treviño AS, Omay SB. et al. Limitations of the endonasal endoscopic approach in treating olfactory groove meningiomas. A systematic review. Acta Neurochir (Wien) 2017; 159 (10) 1875-1885
- 26 Graffeo CS, Dietrich AR, Grobelny B. et al. A panoramic view of the skull base: systematic review of open and endoscopic endonasal approaches to four tumors. Pituitary 2014; 17 (04) 349-356
- 27 Kim DH, Hong YK, Jeun SS. et al. Can tumor size be a predictive factor of olfactory dysfunction after endoscopic endonasal trans-sphenoidal approach?. J Craniofac Surg 2018; 29 (03) 543-546
- 28 Rioja E, Bernal-Sprekelsen M, Enriquez K. et al. Long-term outcomes of endoscopic endonasal approach for skull base surgery: a prospective study. Eur Arch Otorhinolaryngol 2016; 273 (07) 1809-1817
- 29 Ruggeri AG, Cappelletti M, Fazzolari B, Marotta N, Delfini R. Frontobasal midline meningiomas: is it right to shed doubt on the transcranial approaches? Updates and review of the literature. World Neurosurg 2016; 88: 374-382
- 30 Yin LX, Low CM, Puccinelli CL. et al. Olfactory outcomes after endoscopic skull base surgery: a systematic review and meta-analysis. Laryngoscope 2019; 129 (09) 1998-2007
- 31 Blomqvist EH, Brämerson A, Stjärne P, Nordin S. Consequences of olfactory loss and adopted coping strategies. Rhinology 2004; 42 (04) 189-194
- 32 Santos DV, Reiter ER, DiNardo LJ, Costanzo RM. Hazardous events associated with impaired olfactory function. Arch Otolaryngol Head Neck Surg 2004; 130 (03) 317-319
- 33 Stevenson RJ. An initial evaluation of the functions of human olfaction. Chem Senses 2010; 35 (01) 3-20
- 34 Griffiths CF, Cutler AR, Duong HT. et al. Avoidance of postoperative epistaxis and anosmia in endonasal endoscopic skull base surgery: a technical note. Acta Neurochir (Wien) 2014; 156 (07) 1393-1401
- 35 Kim BY, Kang SG, Kim SW. et al. Olfactory changes after endoscopic endonasal transsphenoidal approach for skull base tumors. Laryngoscope 2014; 124 (11) 2470-2475
- 36 Magill ST, Morshed RA, Lucas CG. et al. Tuberculum sellae meningiomas: grading scale to assess surgical outcomes using the transcranial versus transsphenoidal approach. Neurosurg Focus 2018; 44 (04) E9
- 37 Wu A, Garcia MA, Magill ST. et al. Presenting symptoms and prognostic factors for symptomatic outcomes following resection of meningioma. World Neurosurg 2018; 111: e149-e159
- 38 Fry DE, Nedza SM, Pine M, Reband AM, Huang CJ, Pine G. Inpatient and postdischarge outcomes following elective craniotomy for mass lesions. Neurosurgery 2019; 85 (01) E109-E115
- 39 Meskal I, Gehring K, Rutten GJ, Sitskoorn MM. Cognitive functioning in meningioma patients: a systematic review. J Neurooncol 2016; 128 (02) 195-205
- 40 Song SW, Kim YH, Kim JW. et al. Outcomes after transcranial and endoscopic endonasal approach for tuberculum meningiomas-a retrospective comparison. World Neurosurg 2018; 109: e434-e445
- 41 Giammattei L, Starnoni D, Cossu G. et al. Surgical management of Tuberculum sellae Meningiomas: myths, facts, and controversies. Acta Neurochir (Wien) 2020; 162 (03) 631-640
- 42 Ung TH, Yang A, Aref M, Folzenlogen Z, Ramakrishnan V, Youssef AS. Preservation of olfaction in anterior midline skull base meningiomas: a comprehensive approach. Acta Neurochir (Wien) 2019; 161 (04) 729-735
- 43 Pribitkin E, Getz A, Roberge E. et al. Olfactory function following transorbital craniotomy through a suprabrow approach. The Internet Journal of Otorhinolaryngology 2002; 2 (02) 1-6
- 44 Koutourousiou M, Fernandez-Miranda JC, Wang EW, Snyderman CH, Gardner PA. Endoscopic endonasal surgery for olfactory groove meningiomas: outcomes and limitations in 50 patients. Neurosurg Focus 2014; 37 (04) E8
- 45 Puccinelli CL, Yin LX, O'Brien EK. et al. Long-term olfaction outcomes in transnasal endoscopic skull-base surgery: a prospective cohort study comparing electrocautery and cold knife upper septal limb incision techniques. Int Forum Allergy Rhinol 2019; 9 (05) 493-500
- 46 Soler ZM, Smith TL, Alt JA, Ramakrishnan VR, Mace JC, Schlosser RJ. Olfactory-specific quality of life outcomes after endoscopic sinus surgery. Int Forum Allergy Rhinol 2016; 6 (04) 407-413
- 47 Jalessi M, Jahanbakhshi A, Amini E, Kamrava SK, Farhadi M. Impact of nasoseptal flap elevation on sinonasal quality of life in endoscopic endonasal approach to pituitary adenomas. Eur Arch Otorhinolaryngol 2016; 273 (05) 1199-1205
- 48 Jones SH, Iannone AF, Patel KS. et al. The impact of age on long-term quality of life after endonasal endoscopic resection of skull base meningiomas. Neurosurgery 2016; 79 (05) 736-745
- 49 Kahilogullari G, Beton S, Al-Beyati ES. et al. Olfactory functions after transsphenoidal pituitary surgery: endoscopic versus microscopic approach. Laryngoscope 2013; 123 (09) 2112-2119
- 50 Kawabata T, Takeuchi K, Nagata Y. et al. Preservation of olfactory function following endoscopic single-nostril transseptal transsphenoidal surgery. World Neurosurg 2019; 132: e665-e669
- 51 Kim BY, Shin JH, Kang SG. et al. Bilateral modified nasoseptal “rescue” flaps in the endoscopic endonasal transsphenoidal approach. Laryngoscope 2013; 123 (11) 2605-2609