Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
Oper Neurosurg (Hagerstown). 2023 Feb 1;24(2):121-130. doi: 10.1227/ons.0000000000000464. Epub 2022 Nov 1.
There is controversy over the choice of optimal approach for olfactory groove meningiomas (OGM). The endoscopic endonasal approach (EEA) is one of the most recently described corridors, which provides direct access to the tumor base.
To detail the evolution of the endoscopic endonasal technique over the past 2 decades and demonstrate the impact of this evolution on patient outcomes.
This is a retrospective study based on a prospectively maintained database of consecutive cases of OGM operated on at our institution via EEA. For analysis, the whole cohort has been divided into 3 equal "eras" according to the time period during which the surgery happened, creating early, middle, and contemporary groups.
Seventy-five patients were included, 25 in each group. The rate of postoperative cerebrospinal fluid leak significantly decreased over time (28%, 32%, and 8% in the early, middle, and contemporary groups, respectively, P = .020). The rate of postoperative encephalomalacia was significantly lower in more recent groups (24%, 16%, and 0% in the early, middle, and contemporary groups, respectively, P = .029), as was the time to resolution of postoperative brain edema (103.9 months, 87.3 months, and 16.8 months in the early, middle, and contemporary groups, respectively, P = .020).
The endoscopic endonasal approach for OGM significantly evolved over time, achieving lower cerebrospinal fluid leak rates while providing a high rate of Simpson grade 1 resection. Technical improvements minimized the frontal lobe impact. Current data support EEA as a safe and effective corridor to treat OGM.
对于嗅沟脑膜瘤（OGM）的最佳治疗方法存在争议。内镜经鼻入路（EEA）是最近描述的一种通道，可直接到达肿瘤基底。
详细介绍过去 20 年来内镜经鼻技术的发展，并展示这种演变对患者结局的影响。
这是一项基于在我们机构通过 EEA 对 OGM 进行连续手术的前瞻性维护数据库的回顾性研究。为了进行分析，根据手术发生的时间段，将整个队列分为 3 个相等的“时期”，创建早期、中期和当代组。
共纳入 75 例患者，每组 25 例。术后脑脊液漏的发生率随着时间的推移显著降低（早期、中期和当代组分别为 28%、32%和 8%，P =.020）。术后脑软化的发生率在更近的组中明显更低（早期、中期和当代组分别为 24%、16%和 0%，P =.029），术后脑水肿的缓解时间也更短（早期、中期和当代组分别为 103.9 个月、87.3 个月和 16.8 个月，P =.020）。
OGM 的内镜经鼻入路技术随着时间的推移显著发展，脑脊液漏发生率降低，同时实现了较高的 Simpson 分级 1 切除率。技术改进最大限度地减少了额叶的影响。目前的数据支持 EEA 作为治疗 OGM 的安全有效的通道。
