Trans-Sinusal Frontal Approach for Olfactory Groove Meningiomas

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
• 2 Mayfrank L, Gilsbach J M. Interhemispheric approach for microsurgical removal of olfactory groove meningiomas.  Br J Neurosurg . 1996;  10 541-545
• 3 Babu R, Barton A, Kasoff S S. Resection of olfactory groove meningiomas: technical note revisited. Surg Neurol .  1995;  44 567-572
• 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
• 5 Fujitsu K, Saijoh M, Aoki F. Telecanthal approach for meningiomas in the ethmoid and sphenoid sinuses.  Neurosurgery . 1991;  28 714-720
• 6 Kawakami K, Yamanouchi Y, Kubota C. An extensive transbasal approach to frontal skull-base tumors. Technical note.  J Neurosurg . 1991;  74 1011-1013
• 7 Kawakami K, Yamanouchi Y, Kawamura Y, Matsumura H. Operative approach to the frontal skull base: extensive transbasal approach.  Neurosurgery . 1991;  28 720-725
• 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
• 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
• 10 Derome P. Les tumeurs sphéno-ethmoidales. Possibilités d'exérèse et de réparation chirurgicales.  Neurochirurgie . 1972;  1-164 (1-164)
• 11 Kempe L G. Olfactory groove meningioma. In: Operative Neurosurgery Vol 1. New York: Springer-Verlag 1968: 104-108
• 12 Hassler W, Zentner J. Pterional approach for surgical treatment of olfactory groove meningiomas.  Neurosurgery . 1989;  25 942-947
• 13 Paterniti S, Fiore P, Levita A. Venous saving in olfactory meningioma's surgery.  Clin Neurol Neurosurg . 1999;  101 235-237
• 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
• 15 Yasargil M G. Microneurosurgery of CNS Tumors.  Vol IVB. New York: Thieme, 1996: 140-141
• 16 Al Mefty O. Surgical technique for the juxta-sellar area. In: Surgery of the Cranial Base Boston: Kluwer Academic Publishers 1989: 73-89
• 17 Béziat J L, Pierluca P. Les lésions traumatiques des confins crânio-faciaux. Démarche diagnostique et indications thérapeutiques.  Lyon Chir . 1984;  80 333-336
• 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
• 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
• 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
• 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
• 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
• 23 Hallacq P. Abords antérieurs de la base du crâne. Anatomie, techniques et complications, indications Vol I. University of Lyon: Mémoire DES Neurochirurgie; 1995
• 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
• 25 MacBeth R. The osteoplastic operation for chronic infection of the frontal sinus.  Laryngol Otol . 1954;  68 465-477
• 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
• 27 Bergara A R, Itoiz A O. Present state of the surgical treatment of chronic sinusitis.  AMA Arch Otolaryngol . 1955;  61 616-628
• 28 Goodale R L, Montgomery W W. Anterior osteoplastic frontal sinus operation. Five years' experience.  Ann Otol Rhinol Laryngol . 1961;  70 860-880
• 29 Montgomery W W. Osteoplastic frontal sinus operation: coronal incision.  Ann Otol Rhinol Laryngol . 1965;  74 821-830
• 30 Malecki J. New trends in frontal sinus surgery.  Acta Otolaryngol (Stockh) . 1959;  50 137-140
• 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
• 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
• 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
• 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
• 35 Ojemann R G. Meningiomas of the basal parapituitary region: technical considerations.  Clin Neurosurg . 1980;  233-262
• 36 Ojemann R G. Olfactory groove meningiomas. In: Al-Mefty O, ed. Meningiomas New York: Raven Press, 1991: 383-393
• 37 Seeger W. Frontobasal operations. In: Microsurgery of the Cranial Base Berlin: Springer-Verlag 1983: 200-269
• 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
• 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
• 40 Cophignon J, George B, Marchac D, Roux F. Voie transbasale élargie par mobilisation du bandeau fronto-orbitaire médian.  Neurochirurgie . 1983;  29 407-410
• 41 Lesoin F, Pellerin P, Villette L. Mobilisation du bandeau fronto-orbitaire médian par volet monobloc.  Neurochirurgie . 1986;  32 161-163
• 42 Roux F X, Devaux B, Nataf F. Tumeurs malignes de la région ethmoidale. Techniques neurochirurgicales.  Neurochirurgie . 1997;  43 92-99
• 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
• 44 Pinsolle J, San-Galli F, Siberchicot F. Modified approach for ethmoid and anterior skull base surgery.  Arch Otolaryngol . 1991;  117 779-782
• 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
• 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)
• 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
• 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
• 49 Simpson D. The recurrence of intracranial meningiomas.  J Neurol Neurosurg Psychiatry . 1957;  20 22-39
• 50 Samii M, Draf W. Surgery of the Skull Base.  An Interdisciplinary Approach. Berlin: Springer-Verlag; 1989
• 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
• 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
• 53 Spetzler R F, Herman J M, Beals S. Preservation of olfaction in anterior craniofacial approaches.  J Neurosurg . 1993;  79 48-52
• 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
• 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

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