Smell Outcomes in Olfactory Groove Meningioma Resection in Unilateral versus Bilateral Transcranial Approaches: A Systematic Review and Meta-analysis

Introduction: Olfactory disturbance is a common complication that occurs following the surgical resection of olfactory groove meningiomas (OGMs). There is little evidence on the best transcranial approach that minimizes rates of postoperative olfactory disturbance. The objective of this systematic review and meta-analysis is to compare smell outcomes after OGM resection in unilateral vs bilateral transcranial approaches.

Methods: A systematic review of the literature and meta-analysis was conducted in accordance with the PRISMA guidelines, from inception until August 2021. The primary endpoint was incidence of new olfactory disturbance—defined as either anosmia or hyposmia—after OGM resection. Patients were classified as undergoing either a unilateral or bilateral approach. Data from each study on the presence of new postoperative olfactory deficits were used to generate standardized mean differences and 95% confidence intervals, which were combined using inverse variance-weighted averages of standardized mean differences in a random-effects model.

Results: Ten studies met the inclusion criteria for quantitative analysis, comprising 342 patients (205 females, mean age: 55.0 years ± 3.4 years) who were followed up clinically for an average of 61.8 months ± 30.4 months. A total of 231 patients underwent unilateral approaches while 111 underwent resection via bilateral approach. Forty patients (16.5%) in the unilateral approach cohort experienced new postoperative olfactory disturbance following resection, compared with 24 (20.8%) of patients in the bilateral approach cohort. Forest plot did not reveal any significant difference in the incidence of new olfactory disturbance following either unilateral or bilateral approaches.

Conclusion: Our data suggest that there is no significant difference between the investigated transcranial approaches and postoperative olfactory disturbances. Thus, if minimizing postoperative olfactory disturbance is a priority, the choice between a unilateral and bilateral approach should be executed according to which route provides the most appropriate surgical window of accessibility. Accordingly, our study suggests that further investigation with introduced experimental control could provide more insight into the capabilities and drawbacks of each route in relation to olfactory outcomes.

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Artikel online veröffentlicht:
15. Februar 2022