Download PDF
Skull Base 2001; 11(1): 035-046
DOI: 10.1055/s-2001-12786
Copyright © 2001 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

Trans-Sinusal Frontal Approach for Olfactory Groove Meningiomas

Paul Hallacq1 , Jean-Jacques Moreau1 , Georges Fischer2 , Jean-Luc Béziat3
  • 1Department of Neurosurgery, Hôpital Dupuytren, Limoges, France
  • 2Department of Neurosurgery C, Hôpital Pierre Wertheimer, Lyon, France
  • 3Department of Maxillo-Facial Surgery, Hôpital de la Croix-Rousse, Lyon, France
Further Information

Publication History

Publication Date:
31 December 2001 (online)

    Permissions and Reprints

ABSTRACT

The authors report on their experience with the trans-sinusal frontal approach in removing olfactory groove meningiomas. Six tumors were operated on by the trans-sinusal frontal approach, using a bicoronal incision; two tumors developed on one side, and there were four bilateral olfactosellar tumors. Osteotomy of the anterior wall of the frontal sinus was performed with an oscillating saw without any burr hole. The posterior wall of the sinus was resected and the tumor was attacked through a real subfrontal route along the plane of the anterior skull base. Ethmoidal blood supply was controlled at the initial stages of the operation, allowing avascular tumor debulking. Olfactory nerves, invaded by the tumor, were removed along with the tumor. Tumor extensions toward the sella and the optic canals were removed without brain retraction, opening of the Sylvian fissure, or dissection of the carotid arteries. All patients made a good neurologic recovery; intellectual impairment disappeared within 1 month, and visual acuity normalized within 2 weeks. Olfactory nets were preserved on the contralateral side in unilateral tumors. The trans-sinusal frontal approach is technically easy and safe to achieve. Osteotomy and replacement of the anterior wall of the frontal sinus are rapidly performed. When the frontal sinus is small, image-guided surgery allows precise deliniation of its limits and the free bone flap, including the calvarial outer layer, tangentially cut from one supraorbital canal to the other. The cosmetic result is perfect, as the normal contour of the forehead is maintained without any scar or visible burr hole. The trans-sinusal frontal approach gives access to the orbital roofs and to the central anterior skull base from the crista galli to the tuberculum sellae and the anterior clinoid processes. The trans-sinusal frontal approach represents an alternative to conventional craniotomies for tumors developed in the central anterior skull base, especially for olfactory groove meningiomas, whatever their size.

KEYWORD

Anterior skull base - olfactory groove meningioma - frontal sinus approach

REFERENCES

  • 1 Cushing H, Eisenhardt L. The olfactory groove meningiomas with primary anosmia. In: Meningiomas: Their Classification, Regional Behavior, Life History and Surgical End Results Springfield, IL: Charles C Thomas, 1938: 250-273
    Google Scholar
  • 2 Mayfrank L, Gilsbach J M. Interhemispheric approach for microsurgical removal of olfactory groove meningiomas.  Br J Neurosurg . 1996;  10 541-545
    CrossrefPubMedGoogle Scholar
  • 3 Babu R, Barton A, Kasoff S S. Resection of olfactory groove meningiomas: technical note revisited. Surg Neurol .  1995;  44 567-572
    PubMedGoogle Scholar
  • 4 Delfini R, Iannetti G, Belli E. Cranio-facial approaches for tumors involving the anterior half of the skull base.  Acta Neurochir (Wien) . 1993;  124 53-60
    CrossrefPubMedGoogle Scholar
  • 5 Fujitsu K, Saijoh M, Aoki F. Telecanthal approach for meningiomas in the ethmoid and sphenoid sinuses.  Neurosurgery . 1991;  28 714-720
    PubMedGoogle Scholar
  • 6 Kawakami K, Yamanouchi Y, Kubota C. An extensive transbasal approach to frontal skull-base tumors. Technical note.  J Neurosurg . 1991;  74 1011-1013
    PubMedGoogle Scholar
  • 7 Kawakami K, Yamanouchi Y, Kawamura Y, Matsumura H. Operative approach to the frontal skull base: extensive transbasal approach.  Neurosurgery . 1991;  28 720-725
    PubMedGoogle Scholar
  • 8 Sekhar L N, Nanda A, Sen C N. The extended frontal approach to tumors of the anterior, middle, and posterior skull base.  J Neurosurg . 1992;  76 198-206
    CrossrefPubMedGoogle Scholar
  • 9 Sen C, Sekhar L N. An extended subfrontal approach to the skull base. In: Rengachary SS, Wilkins RH, eds. Neurosurgical Operative Atlas Vol 2. Baltimore: Williams & Wilkins, 1992: 97-106
    Google Scholar
  • 10 Derome P. Les tumeurs sphéno-ethmoidales. Possibilités d'exérèse et de réparation chirurgicales.  Neurochirurgie . 1972;  1-164 (1-164)
    PubMedGoogle Scholar
  • 11 Kempe L G. Olfactory groove meningioma. In: Operative Neurosurgery Vol 1. New York: Springer-Verlag 1968: 104-108
    Google Scholar
  • 12 Hassler W, Zentner J. Pterional approach for surgical treatment of olfactory groove meningiomas.  Neurosurgery . 1989;  25 942-947
    CrossrefPubMedGoogle Scholar
  • 13 Paterniti S, Fiore P, Levita A. Venous saving in olfactory meningioma's surgery.  Clin Neurol Neurosurg . 1999;  101 235-237
    CrossrefPubMedGoogle Scholar
  • 14 Turazzi S, Cristofori L, Gambin R, Bricolo A. The pterional approach for the microsurgical removal of olfactory groove meningiomas.  Neurosurgery . 1999;  45 821-826
    CrossrefPubMedGoogle Scholar
  • 15 Yasargil M G. Microneurosurgery of CNS Tumors.  Vol IVB. New York: Thieme, 1996: 140-141
    Google Scholar
  • 16 Al Mefty O. Surgical technique for the juxta-sellar area. In: Surgery of the Cranial Base Boston: Kluwer Academic Publishers 1989: 73-89
    Google Scholar
  • 17 Béziat J L, Pierluca P. Les lésions traumatiques des confins crânio-faciaux. Démarche diagnostique et indications thérapeutiques.  Lyon Chir . 1984;  80 333-336
    PubMedGoogle Scholar
  • 18 Béziat J L, Pierluca P, Freidel M. L'abord des lésions traumatiques des confins crânio-faciaux par voies trans- lésionnelle et trans-sinusienne.  Ann Chir Plast Esthet . 1985;  30 236-240
    PubMedGoogle Scholar
  • 19 Béziat J L, Rémond J, Pialat J, Mazoyer J F. Les voies d'abord faciales des structures médianes de la base du crâne.  Rev Stomatol Chir Maxillofac . 1997;  98 183-206
    PubMedGoogle Scholar
  • 20 Villette L, Lepoutre F, Lesoin F. Traitement des brèches ostéo-durales de l'étage antérieur de la base du crâne par voie trans-lésionnelle. A propos de 25 cas opérés en double équipe neurochirurgicale et maxillo-faciale.  Rev Stomatol Chir Maxillofac . 1989;  90 73-78
    PubMedGoogle Scholar
  • 21 Hallacq P, Moreau J JM, Fischer G, Béziat J L. Voie trans-sinusienne frontale pour les méningiomes de la gouttière olfactive. Note technique.  Neurochirurgie . 1999;  45 329-337
    PubMedGoogle Scholar
  • 22 Bonnal J, Sedan R, Paillas J E. Problèmes cliniques, évolutifs et thérapeutiques soulevés par les méningiomes envahissants de la base du crâne.  Neurochirurgie . 1961;  2 108-117
    PubMedGoogle Scholar
  • 23 Hallacq P. Abords antérieurs de la base du crâne. Anatomie, techniques et complications, indications Vol I. University of Lyon: Mémoire DES Neurochirurgie; 1995
    Google Scholar
  • 24 Gibson T, Walker F M. Large osteoma of the frontal sinus. A method of removal to minimise scarring and prevent deformity.  Br J Plast Surg . 1951;  4 210-217
    PubMedGoogle Scholar
  • 25 MacBeth R. The osteoplastic operation for chronic infection of the frontal sinus.  Laryngol Otol . 1954;  68 465-477
    PubMedGoogle Scholar
  • 26 Tato J M, Sibbald D W, Bergaglio O E. Surgical treatment of the frontal sinus by the external route.  Laryngoscope . 1954;  64 504-521
    PubMedGoogle Scholar
  • 27 Bergara A R, Itoiz A O. Present state of the surgical treatment of chronic sinusitis.  AMA Arch Otolaryngol . 1955;  61 616-628
    CrossrefPubMedGoogle Scholar
  • 28 Goodale R L, Montgomery W W. Anterior osteoplastic frontal sinus operation. Five years' experience.  Ann Otol Rhinol Laryngol . 1961;  70 860-880
    PubMedGoogle Scholar
  • 29 Montgomery W W. Osteoplastic frontal sinus operation: coronal incision.  Ann Otol Rhinol Laryngol . 1965;  74 821-830
    PubMedGoogle Scholar
  • 30 Malecki J. New trends in frontal sinus surgery.  Acta Otolaryngol (Stockh) . 1959;  50 137-140
    PubMedGoogle Scholar
  • 31 Colohan A RT, Jane J A, Newman S A, Maggio W W. Frontal sinus approach to the orbit. Technical note.  J Neurosurg . 1985;  63 811-813
    PubMedGoogle Scholar
  • 32 Colohan A RT, Jane J A, Park T S, Persing J A. Bifrontal osteoplastic craniotomy utilizing the anterior wall of the frontal sinus: technical note.  Neurosurgery . 1985;  16 822-824
    PubMedGoogle Scholar
  • 33 Jane J A. Frontal approach to orbital and parasellar structures. In: Wilson CB, eds. Neurosurgical Procedures. Personal Approaches to Classic Operations Baltimore: Williams & Wilkins, 1992: 10-20
    Google Scholar
  • 34 Persing J A, Jane J A, Levine P A, Cantrell R W. The versatile frontal sinus approach to the floor of the anterior cranial fossa.  J Neurosurg . 1990;  72 513-516
    PubMedGoogle Scholar
  • 35 Ojemann R G. Meningiomas of the basal parapituitary region: technical considerations.  Clin Neurosurg . 1980;  233-262
    PubMedGoogle Scholar
  • 36 Ojemann R G. Olfactory groove meningiomas. In: Al-Mefty O, ed. Meningiomas New York: Raven Press, 1991: 383-393
    Google Scholar
  • 37 Seeger W. Frontobasal operations. In: Microsurgery of the Cranial Base Berlin: Springer-Verlag 1983: 200-269
    Google Scholar
  • 38 Snyderman C H, Costantino P D, Sekhar L N. Anterior approaches to the cranial base. In: Apuzzo MLJ, ed. Brain Surgery: Complication Avoidance and Management New York: Churchill Livingstone, 1993: 2265-2281
    Google Scholar
  • 39 Biedlingmaier J F, Lester N. The free bone flap approach to the frontal sinus in the high-risk orbital patient.  Laryngoscope . 1995;  105 1138-1140
    PubMedGoogle Scholar
  • 40 Cophignon J, George B, Marchac D, Roux F. Voie transbasale élargie par mobilisation du bandeau fronto-orbitaire médian.  Neurochirurgie . 1983;  29 407-410
    PubMedGoogle Scholar
  • 41 Lesoin F, Pellerin P, Villette L. Mobilisation du bandeau fronto-orbitaire médian par volet monobloc.  Neurochirurgie . 1986;  32 161-163
    PubMedGoogle Scholar
  • 42 Roux F X, Devaux B, Nataf F. Tumeurs malignes de la région ethmoidale. Techniques neurochirurgicales.  Neurochirurgie . 1997;  43 92-99
    PubMedGoogle Scholar
  • 43 Darrouzet V, San-Galli F, Portmann D. La voie trans-fronto-nasale. Evolution de la chirurgie par voie mixte des tumeurs ethmoidales. Expérience de 12 cas.  Rev Laryngol . 1993;  114 217-220
    PubMedGoogle Scholar
  • 44 Pinsolle J, San-Galli F, Siberchicot F. Modified approach for ethmoid and anterior skull base surgery.  Arch Otolaryngol . 1991;  117 779-782
    PubMedGoogle Scholar
  • 45 Raveh J, Laedrach K, Speiser M. The subcranial approach for fronto-orbital and anteroposterior skull-base tumors.  Arch Otolaryngol Head Neck Surg . 1993;  119 385-393
    CrossrefPubMedGoogle Scholar
  • 46 Auque J, Civit T h. Les dangers du sacrifice du sinus longitudinal supérieur dans son tiers antérieur lors de la chirurgie des méningiomes olfactifs.  Neurochirurgie . 1996;  84-87 (84-87)
    PubMedGoogle Scholar
  • 47 Bret P, Trepsat F, Massini B. Exclusion d'une malformation artério-veineuse de la gouttière olfactive gauche par ligature endo-orbitaire des artères ethmoidales.  Neurochirurgie . 1986;  32 440-447
    PubMedGoogle Scholar
  • 48 Salibi B S, Myers W O, Gildersleeve J W. En bloc removal of large bilateral olfactory groove meningioma.  Surg Neurol . 1978;  9 264-266
    PubMedGoogle Scholar
  • 49 Simpson D. The recurrence of intracranial meningiomas.  J Neurol Neurosurg Psychiatry . 1957;  20 22-39
    CrossrefPubMedGoogle Scholar
  • 50 Samii M, Draf W. Surgery of the Skull Base.  An Interdisciplinary Approach. Berlin: Springer-Verlag; 1989
    Google Scholar
  • 51 Fujitsu K, Sekino T, Sakata K, Kawasaki T. Basal interfalcine approach through a frontal sinusotomy with vein and nerve preservation.  J Neurosurg . 1994;  80 575-579
    PubMedGoogle Scholar
  • 52 Sepehrnia A, Knopp U. Preservation of the olfactory tract in bifrontal craniotomy for various lesions of the anterior cranial fossa.  Neurosurgery . 1999;  44 113-117
    PubMedGoogle Scholar
  • 53 Spetzler R F, Herman J M, Beals S. Preservation of olfaction in anterior craniofacial approaches.  J Neurosurg . 1993;  79 48-52
    CrossrefPubMedGoogle Scholar
  • 54 Sanchez-Vasquez M A, Barrera-Calatayud P, Meija-Villela M. Transciliary subfrontal craniotomy for anterior skull base lesions. Technical note.  J Neurosurg . 1999;  91 892-896
    PubMedGoogle Scholar
  • 55 Cheney M L, Gliklich R, Li K K. Midforehead incision. An approach to the frontal sinus and upper face.  J Craniofac Surg . 1995;  6 408-411
    CrossrefPubMedGoogle Scholar

1 1. Jho HD. Orbital roof craniotomy via an eyebrow incision: a simplified anterior skull base approach. Minimally Invasive Neurosurg 1997;40:91-97

2 2. Jho HD, Ko Y. Glabellar approach: simplified midline anterior skull base approach. Minimally Invasive Neurosurgery 1997;40:62-67

      >