[Postoperative olfactory dysfunction in interhemispheric approach for ruptured anterior communicating artery aneurysms].

Between 1969 and 1994 we treated 450 patients with ruptured anterior communicating artery aneurysms, of which 434 cases (96.4%) were operated on via the interhemispheric approach (IH), namely, until 1979 mainly, via bifrontal craniotomy, subfrontal and interhemispheric approach (SIH) and, since 1979, via posterior interhemispheric approach (PIH). Postoperative olfactory dysfunction is one of the main disadvantages of IH. The mechanisms and the incidence of this disadvantage were studied in both approaches. The causes of postoperative anosmia in SIH were as follows: sectioning of olfactory tracts intentionally or not, avulsion of olfactory bulbs and probability of ischemic or minor mechanical insults to olfactory tracts. However, these matters rarely occur in PIH because of little exposure of olfactory nerves. The mechanisms of postoperative anosmia in PIH were considered to be as follows: sinking of frontal lobes due to excessive drainage of cerebrospinal fluid and over-retraction of frontal lobes. The incidence of postoperative anosmia decreased from 27.0% via SIH to 5.5% via PIH.