Division of Neurosurgery, Department of Neuroscience, University of Turin, Corso Bramante 88/90, 10126, Turin, Italy.
Division of Neurosurgery, Department of Neuroscience, University of Turin, Corso Bramante 88/90, 10126, Turin, Italy.
Clin Neurol Neurosurg. 2020 Sep;196:106041. doi: 10.1016/j.clineuro.2020.106041. Epub 2020 Jun 24.
Olfactory groove meningiomas (OGMs) account for 8-13 % of all intracranial meningiomas. The gold standard of treatment is generally surgery, however various approaches have been used and the literature is still uncertain about the superiority of one treatment over the others. The most debated techniques are traditional microscopic open approaches versus the endoscopic endonasal ones. The aim of this paper is to prove a valid surgical route that gathers the benefits of both endoscopic and transcranial routes.
Fifty consecutive patients underwent trans-frontal sinus surgical removal of an OGM between January 2000 and January 2019 at the Neurosurgical Departments in Torino, Brescia and Legnano (Italy). The clinical features were collected in a database and compared with neuroimaging and outcomes. All patients were investigated with neuroimaging techniques. Clinical evaluations were performed 3-4 months and 1 year after surgery, together with neuroradiological follow-up.
All patients with OGM underwent Simpson grade I resection. The most common neurological symptom leading to neuroradiological evaluations were headaches (36 %), followed by behavioural changes (30 %), hyposmia/anosmia (12 %), visual impairments (6%) and focal deficits (6%). At 3-4 months follow-up 48 patients underwent a brain MRI (2 patients underwent a brain CT), and a complete resection was confirmed in 45 patients (94 %).
Despite different techniques and studies supported by good evidence, there is no consensus on the best surgical approach for OGMs. The data shown in this article suggests that the trans-frontal sinus approach is a valid alternative to an endoscopic approach and the classical transcranial routes, collecting benefits from both approaches.
嗅沟脑膜瘤（OGM）占所有颅内脑膜瘤的 8-13%。一般来说，治疗的金标准是手术，但各种方法都有使用，文献对于一种治疗方法优于其他方法仍存在争议。最具争议的技术是传统的显微镜开颅入路与内镜经鼻入路。本文旨在证明一种有效的手术途径，它结合了内镜和经颅途径的优势。
2000 年 1 月至 2019 年 1 月，神经外科部门在意大利的都灵、布雷西亚和莱尼亚诺对 50 例 OGM 患者进行了经额窦鼻窦手术切除。在数据库中收集了临床特征，并与神经影像学和结果进行了比较。所有患者均接受神经影像学技术检查。术后 3-4 个月和 1 年进行临床评估，并进行神经影像学随访。
所有 OGM 患者均行 Simpson 分级 I 切除术。导致神经影像学评估的最常见神经症状是头痛（36%），其次是行为改变（30%）、嗅觉减退/丧失（12%）、视力障碍（6%）和局灶性缺损（6%）。在 3-4 个月的随访中，48 例患者接受了脑 MRI（2 例患者接受了脑 CT），45 例患者（94%）证实了完全切除。
尽管有不同的技术和良好证据支持的研究，但对于 OGM 最佳手术方法仍未达成共识。本文显示的数据表明，经额窦入路是内镜入路和经典经颅入路的有效替代方法，从两种方法中获益。
