Comprehensive Meta-Analysis Assessing Surgical Resection Approaches for Olfactory Groove Meningiomas: A Comparative Analysis of Outcomes.

Background: Surgical resection of olfactory groove meningioma (OGM) traditionally utilized a transcranial approach (TCAs) for tumor removal. However, after the adoption of the endoscopic endonasal approach for pituitary surgery, skull base surgeons recognized the potential benefits of this technique for OGM. In contrast, to a transcranial resection, the endoscopic approach provides direct tumor access without the need for craniotomy, improving patient-reported quality of life outcomes. However, the efficacy of an extended endoscopic approach (EEA) for larger tumors is still under debate. This study seeks to compare the efficacy of different OGM resection methods and their respective outcomes.

Methods: We conducted a systematic review and meta-analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. We searched PubMed, Scopus, Web of Science, Ovid, and Embase databases to identify pertinent studies. Our primary endpoints included tumor recurrence, immediate and late complications, and hospital length of stay. We calculated standardized mean and risk differences along with their 95% confidence intervals.

Results: From the initial 1,405 studies identified, 69 full-text studies were assessed for eligibility, and 26 studies met the inclusion criteria. These comprised seven case series and 19 cohort studies. A total of 895 patients were included in the analysis with a mean age of 56.29 (IQR: 52.5–60.15) years old and a M:F of 1:1.8. Most patients underwent OGM resection using the TCA approach (786, or 87.2%). Among these, 31% had a supraorbital approach, 27% bifrontal, 8.1% pterional, 10.4% frontolateral, and 7.7% interhemispheric. In contrast, 113 patients, or 12.6%, underwent OGM resection through an EEA approach using the bilateral anterior cranial fossa resection technique. The recurrence rate for the TCA approach was 0.041%, while the EEA cohort had a rate of 7%. The calculated risk difference for recurrence between TCA and EEA was 0.08 (95% CI: −0.26 to 0.43) and the pooled risk difference for CSF leak was –0.02 (95% CI: −0.18 to 0.12). The pooled mean difference in hospital stay was −1.5 days (95% CI: −6.34 to 3.31) implying shorter length of the stay in TCA group compared to EEA. Forest plots revealed no significant differences in recurrence, CSF leak, and length of stay between the TCA and EEA approaches.

Conclusion: This systematic review and meta-analysis indicate that TCA and EEA approaches for OGM resection have comparable outcomes in terms of recurrence, complications, and length of stay. Future research should focus on other quality of life metrics such olfactory dysfunction, persistent headache, and postoperative cognition ([Figs. 1] and [2]).

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Publication History

Article published online:
05 February 2024