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.
