Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA.
Department of Neurosurgery, Mayo Clinic, Jacksonville, Florida, USA; School of Medicine, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania, USA.
World Neurosurg. 2023 Feb;170:e324-e330. doi: 10.1016/j.wneu.2022.11.015. Epub 2022 Nov 11.
There are several different approaches to large and giant olfactory-groove meningiomas (OGMs). Each approach has advantages and disadvantages. We present our series using a unilateral supraorbital keyhole approach avoiding the frontal sinus for the resection of large and giant OGMs without the use of fixed brain retractors or orbital rim removal.
All consecutive patients operated on for large (>3 cm in largest diameter) and giant (>5 cm) OGMs by the senior author from 2016 to 2021 were prospectively identified and retrospectively reviewed. Patients who were operated on using an endoscopic endonasal approach were excluded. No fixed retraction was used.
In total, 14 consecutive patients (11 with large, 3 with giant) were included. All patients were female, with an average age ± standard deviation of 59.7 ± 11.5 years. The median [interquartile range] preoperative Karnofsky Performance Status score was 80 [80-88]. The median preoperative tumor diameter and volume were 3.8 [3.2-4.2] cm and 22.2 [10.5-25.2] cm, respectively. All patients underwent gross total resection. The median hospital stay was 2.7 [2-3] days, with all patients being discharged to home. No patients incurred any postoperative medical and/or surgical complications. Of the 9 patients who had subjective smell preoperatively, 5 stated they had subjective olfaction after surgery.
We demonstrate the utility of a unilateral supraorbital keyhole approach avoiding the frontal sinus for large and giant OGMs. The potential advantages of this approach are minimizing bilateral brain manipulation, avoiding the frontal sinus and potential mucoceles, and reducing the risk of cerebrospinal fluid leaks.
对于大型和巨大嗅沟脑膜瘤（OGM），有几种不同的手术方法。每种方法都有其优缺点。我们采用单侧眶上锁孔入路，避免使用固定的脑牵开器或眶缘切除术，通过该方法切除大型和巨大 OGM，介绍我们的系列治疗经验。
从 2016 年至 2021 年，高级作者对所有连续接受大型（最大直径>3cm）和巨大（>5cm）OGM 手术的患者进行前瞻性识别并进行回顾性研究。排除接受内镜经鼻入路手术的患者。未使用固定牵开器。
共纳入 14 例连续患者（11 例大型，3 例巨大）。所有患者均为女性，平均年龄±标准差为 59.7±11.5 岁。术前 Karnofsky 表现状态评分中位数[四分位数范围]为 80[80-88]。术前肿瘤直径和体积的中位数[四分位数范围]分别为 3.8[3.2-4.2]cm 和 22.2[10.5-25.2]cm。所有患者均行大体全切除。中位住院时间为 2.7[2-3]天，所有患者均出院回家。无患者发生任何术后内科和/或外科并发症。术前有主观嗅觉的 9 例患者中，5 例术后自述有主观嗅觉。
我们证明了单侧眶上锁孔入路避免使用额窦治疗大型和巨大嗅沟脑膜瘤的有效性。该方法的潜在优势包括最大限度减少双侧脑操作、避免额窦和潜在的黏膜囊肿，以及降低脑脊液漏的风险。
