Unilateral versus Bilateral Approaches for Resection of Olfactory Groove Meningiomas: A Comparative Meta-analysis

Introduction: While transcranial approaches (TCA) have historically been the standard for olfactory groove meningioma (OGM) resection, endoscopic endonasal approaches (EEA) have become increasingly popular. Here we systematically review the extant literature to highlight the advantages of bilateral versus unilateral approaches and EEA versus TCA for OGM, focusing on complications, extent of resection, and local recurrence rates.

Methods: PubMed, Scopus, and Web of Science databases were queried to identify all primary prospective trials and retrospective series comparing outcomes following EEA versus TCA and unilateral versus bilateral craniotomy for surgical resection of OGMs. All articles were screened against title and abstract by two independent authors; those eligible for full-text inclusion were also screened by two authors.

Results: Of 111 unique results, 7 studies comprising 288 total patients (mean age 55.0 ± 24.6 years) met criteria for inclusion in the meta-analysis: 4 compared unilateral and bilateral approaches and 3 compared EEA and TCA approaches. In the three comparing EEA (n = 21) versus TCA (n = 32), there was no significant difference between EEA and TCA with respect to GTR (OR 0.37 [0.05, 2.83], I2 = 32%, p = 0.34) or rates of Simpson Grade 1 resection (OR 1.77 [0.11, 28.97], I2 = 69, p = 0.69). Overall complication rates were similar except that TCA showed higher rates of postoperative infection [(OR 6.21 [1.19, 32.36], I2 = 0%, (p = 0.03)]. EEA was associated with a nonsignificant lower odds olfaction preservation [(OR 0.05 [0.00, 1.34], (p = 0.07)]. In the four studies comparing bilateral (n = 117) versus unilateral approaches (n = 118), overall complication rates (OR 4.94 [1.75, 13.99], I2 = 0.00%, p = 0.003) and disease recurrence (OR 5.99 [1.44, 24.88], I2 = 0.00%, p = 0.01) were higher with bilateral approaches. All surgery-related mortalities also occurred in the bilateral cohort (n = 7, 7.14%). Extent of resection, as assessed by both GTR (p = 0.63) and Simpson grade (p = 0.48) were comparable between approaches. Olfaction preservation was superior for unilateral approaches (OR 0.25 [0.10, 0.61], I2 = 0.00%, p = 0.003), which also had lower rates of olfactory functional decline (OR 4.03 [1.63, 9.94], I2 = 0.00%, p = 0.003)

Conclusions: Though the literature is limited, where craniotomy is used, unilateral approaches appear to reduce complications and the risk of olfaction loss. Additional multi-center collaborations outlining the anatomic indications for each procedure are needed.

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Artikel online veröffentlicht:
05. Februar 2024