Babu R, Barton A, Kasoff S S
Department of Neurosurgery, New York Medical College, Valhalla, USA.
Surg Neurol. 1995 Dec;44(6):567-72. doi: 10.1016/0090-3019(95)00196-4.
Although large olfactory groove meningiomas present in the midline, tumor volume is often unequally distributed to one side. Most surgeons favor a bifrontal craniotomy with retraction or partial resection of the frontal lobes to resect these tumors. However, frontal lobe retraction is not without complications.
We present a technical note regarding the resection of these large olfactory groove meningiomas. We describe the advantages of a unilateral frontal craniotomy complemented with orbital osteotomy.
The orbital osteotomy has considerably reduced the need for frontal lobe retraction and avoids partial resection of the frontal lobe to uncap the tumor. Utilizing this approach we have been able to remove the tumor from one side, followed by an incision to the falx cerebri in order to remove the tumor from the other side. With this approach, we have gained excellent visualization of the tumor in its entirety. Moreover, this approach permits the surgeon to intercept the arteries emerging from the skull base during the initial stages of the procedure.
Unilateral frontal craniotomy and orbital osteotomy has obviated the need to retract or resect the frontal lobe when resecting large olfactory groove meningiomas, which extend to either side of the falx. Because surgery is performed from one side, olfaction may also be preserved on the contralateral side.
尽管大型嗅沟脑膜瘤位于中线，但肿瘤体积往往向一侧不均匀分布。大多数外科医生倾向于采用双额开颅术并牵拉或部分切除额叶来切除这些肿瘤。然而，额叶牵拉并非没有并发症。
我们介绍了关于切除这些大型嗅沟脑膜瘤的技术说明。我们描述了单侧额开颅术辅以眶骨切开术的优点。
眶骨切开术大大减少了额叶牵拉的必要性，避免了为暴露肿瘤而部分切除额叶。采用这种方法，我们能够从一侧切除肿瘤，然后切开大脑镰以从另一侧切除肿瘤。通过这种方法，我们能够很好地完整观察肿瘤。此外，这种方法允许外科医生在手术初始阶段拦截从颅底发出的动脉。
单侧额开颅术和眶骨切开术在切除延伸至大脑镰两侧的大型嗅沟脑膜瘤时，无需牵拉或切除额叶。由于手术从一侧进行，对侧嗅觉也可能得以保留。
