Maiuri Francesco, Corazzelli Giuseppe, Berardinelli Jacopo, Corvino Sergio
Department of Neurosciences and Reproductive and Odontostomatological Sciences, University of Naples "Federico II", Naples, 80131, Italy.
Neurosurgery Department, Santa Maria delle Grazie Hospital, ASL Napoli 2, Nord, Naples, 80078, Italy.
Neurosurg Rev. 2025 Jul 12;48(1):562. doi: 10.1007/s10143-025-03716-6.
Recurrences of olfactory groove meningiomas (OGMs) sometimes occur even after gross total resection. The present study discusses the risk factors of recurrences and the most important surgical steps at initial surgery to reduce the recurrence rate.
A monoinstitutional series of 60 patients with OGMs operated through microsurgical transcranial approaches and a comprehensive systematic literature review on recurrent OGMs operated via transcranial approaches (TCAs) (Group A) or endoscopic endonasal approach (EEA) (Group B) were retrospectively and separately analyzed. The analyzed factors included patient age, prior surgeries, tumor size, extent of resection at initial surgery, management of basal bone invasion, dural attachment, optic canals invasion, anterior cerebral arteries (ACAs) encasement, follow-up. All these data were statistically correlated with the recurrence rate. The review investigation followed a prespecified protocol registered on PROSPERO (PROSPERO 2024 CRD420250655908).
48 studies met the inclusion criteria for an overall sample of 1498 patients, of which 1377 (38 studies) belonging to the group A and 121 (10 studies) belonging to group B. The overall recurrence rate was 6.6% after TCAs and 7.4% after EEA (p > 0.9); however, the median follow up was longer in group A (72.5 ± 29.6 months) compared to group B (32.3 ± 12.9 months) (p < 0.01). Studies of patients treated by TCAs showed higher median values of gross total resection (GTR) (92.5%) than studies on patients treated by EEA (67.7%) (p < 0.01). The median recurrence rate after GTR was 4.7% in group A and 5.6% in group B (p > 0.9). In group A the resection of the dural attachment (reported in 46% of the reviewed patients) resulted in further decrease of the recurrence rate (3.2%). Optic canal extension was significantly more frequent in group A (57.3%) than in group B (21.5%) (p < 0.01).
Resection of infiltrated basal bone and dural attachment during TCAs, mainly in young anosmic patients, may reduce the recurrence rate. Residual intracranial tumor nodules and peripheral dural infiltration must be avoided during the EEA. Decompression of the optic nerves and resection of tumor extending into the optic canals is mandatory in both approaches to minimize the recurrence risk.
Not applicable.
嗅沟脑膜瘤（OGM）即使在全切术后有时也会复发。本研究探讨复发的危险因素以及初次手术时最重要的手术步骤以降低复发率。
对60例经显微外科经颅入路手术的OGM患者进行单中心系列研究，并对经颅入路（TCA）（A组）或鼻内镜下经鼻入路（EEA）（B组）手术的复发性OGM进行全面系统的文献回顾，分别进行回顾性分析。分析的因素包括患者年龄、既往手术史、肿瘤大小、初次手术切除范围、基底骨侵犯的处理、硬脑膜附着情况、视神经管侵犯、大脑前动脉（ACA）包绕、随访情况。所有这些数据均与复发率进行统计学相关分析。该综述调查遵循在PROSPERO上注册的预先指定方案（PROSPERO 2024 CRD420250655908）。
48项研究符合纳入标准，总样本量为1498例患者，其中1377例（38项研究）属于A组，121例（10项研究）属于B组。TCA术后总体复发率为6.6%，EEA术后为7.4%（p＞0.9）；然而，A组的中位随访时间（72.5±29.6个月）比B组（32.3±12.9个月）长（p＜0.01）。TCA治疗患者的研究显示全切（GTR）的中位值（92.5%）高于EEA治疗患者的研究（67.7%）（p＜0.01）。GTR术后A组的中位复发率为4.7%，B组为5.6%（p＞0.9）。在A组中，切除硬脑膜附着（在所审查患者中的46%报告）导致复发率进一步降低（3.2%）。A组视神经管受累明显比B组更常见（57.3%对21.5%）（p＜0.01）。
在TCA过程中切除浸润的基底骨和硬脑膜附着，主要针对年轻嗅觉丧失患者，可能会降低复发率。在EEA过程中必须避免残留颅内肿瘤结节和外周硬脑膜浸润。在两种入路中对视神经进行减压并切除延伸至视神经管的肿瘤对于将复发风险降至最低都是必要的。
不适用。
