title: Permanent anosmia and ageusia after resection of a left temporoinsular low-grade glioma: anatomofunctional considerations.
abstract: Five percent of the general population has olfactory or gustatory disorders, although most do not complain about it. However, in some cases, these symptoms can be disabling and may affect quality of life. Anosmia was reported as a possible complication following head injury and neurosurgical procedures, particularly after the resection of tumors located in the anterior fossa and the treatment of aneurysms in the anterior circulation. Nonetheless, in all of these situations, olfactory dysfunction could be explained by damage to the peripheral olfactory system.   Here, the authors report a case of complete anosmia associated with ageusia following awake resection of a low-grade glioma involving the left temporoinsular region, with no recovery during a follow-up of 3 years. The frontal lobe was not retracted, and the olfactory tract was not visualized during surgery; therefore, postoperative anosmia and ageusia are likely explained by damage to the cortex and central pathways responsible for these senses. The authors suggest that the patient might have had a subclinical right hemianosmia before surgery, which is a common condition. After resection of the central structures critical for smell and taste processing in the left hemisphere, the patient could have finally had bilateral and complete olfactory and gustatory loss.   This is the first known report of permanent anosmia and ageusia following glioma surgery. Because these symptoms might have been underestimated, more attention should be devoted to olfaction and taste, especially with regard to possible subclinical preoperative deficit.
authors.affiliation: Department of Neurosurgery, Hospital das Clinicas of the University of São Paulo, Brazil.
authors.forename: Eduardo Santamaria Carvalhal
authors.initials: ES
authors.lastname: Ribas
authors.forename: Hugues
authors.initials: H
authors.lastname: Duffau
mesh_terms: D000370:Ageusia / Q000209:etiology*; D000758:Anesthesia; D001932:Brain Neoplasms / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D002540:Cerebral Cortex / Q000473:pathology; D003399:Craniotomy; D004525:Efferent Pathways / Q000293:injuries / Q000473:pathology; D005260:Female; D005910:Glioma / Q000150:complications / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D000857:Olfaction Disorders / Q000209:etiology*; D009833:Olfactory Pathways / Q000473:pathology; D011183:Postoperative Complications / Q000473:pathology* / Q000523:psychology; D012640:Seizures / Q000209:etiology; D013702:Temporal Lobe / Q000473:pathology / Q000601:surgery