Brown Nolan J, Pennington Zach, Patel Saarang, Kuo Cathleen, Chakravarti Sachiv, Bui Nicholas E, Gendreau Julian, Van Gompel Jamie J
Department of Neurosurgery, University of California, Irvine, Orange, California, United States.
Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, United States.
J Neurol Surg B Skull Base. 2024 Apr 30;86(2):208-220. doi: 10.1055/a-2297-9055. eCollection 2025 Apr.
Here we systematically review the extant literature to highlight the advantages of bilateral versus unilateral approaches and endoscopic endonasal (midline) approaches versus transcranial approaches for olfactory groove meningiomas, focusing on complications, extent of resection, and local recurrence rates. Three databases were queried to identify all primary prospective trials and retrospective series comparing outcomes following endoscopic endonasal versus transcranial approaches and unilateral versus bilateral craniotomy for surgical resection of olfactory groove meningiomas. All articles were screened by two independent authors and selected for formal analysis according to predefined inclusion/exclusion criteria. Seven studies comprising 288 total patients (mean age 55.0 ± 24.6 years) met criteria for inclusion. In the three comparing the endoscopic endonasal ( = 21) versus transcranial ( = 32) approaches, there was no significant difference between the two with respect to gross total resection ( = 0.34) or rates of Simpson Grade 1 resection ( = 0.69). EEA demonstrated higher rates of overall complications ( < 0.01) including postoperative infection ( = 0.03). In the four studies comparing bilateral ( = 117) versus unilateral approaches ( = 118), overall complication rates ( < 0.01) and disease recurrence ( = 0.01) were higher with bilateral approaches. All surgery-related mortalities also occurred in the bilateral cohort ( = 7, 7.14%). Gross total resection ( = 0.63) and Simpson grade ( = 0.48) were comparable between approaches. Olfaction preservation was superior for unilateral approaches ( < 0.01). Though the literature is limited, current evidence suggests that the endoscopic endonasal approach may be favorable over conventional craniotomy for select olfactory groove meningioma patients. Where craniotomy is used, unilateral approaches appear to reduce complications and the risk of olfaction loss.
在此，我们系统回顾现有文献，以突出双侧与单侧手术入路以及经鼻内镜（中线）入路与经颅入路在嗅沟脑膜瘤治疗中的优势，重点关注并发症、切除范围及局部复发率。查询了三个数据库，以确定所有比较经鼻内镜与经颅入路以及单侧与双侧开颅手术切除嗅沟脑膜瘤后结局的主要前瞻性试验和回顾性系列研究。所有文章均由两名独立作者进行筛选，并根据预定义的纳入/排除标准选择进行正式分析。七项研究共纳入288例患者（平均年龄55.0±24.6岁），符合纳入标准。在三项比较经鼻内镜入路（n = 21）与经颅入路（n = 32）的研究中，两者在全切除率（P = 0.34）或辛普森1级切除率（P = 0.69）方面无显著差异。经鼻内镜入路的总体并发症发生率更高（P < 0.01），包括术后感染（P = 0.03）。在四项比较双侧入路（n = 117）与单侧入路（n = 118）的研究中，双侧入路的总体并发症发生率（P < 0.01）和疾病复发率（P = 0.01）更高。所有与手术相关的死亡也均发生在双侧队列中（n = 7，7.14%）。两种入路的全切除率（P = 0.63）和辛普森分级（P = 0.48）相当。单侧入路在嗅觉保留方面更具优势（P < 0.01）。尽管文献有限，但目前的证据表明，对于某些嗅沟脑膜瘤患者，经鼻内镜入路可能优于传统开颅手术。若采用开颅手术，单侧入路似乎可减少并发症及嗅觉丧失的风险。
