Comparison of endoscopic endonasal and bifrontal craniotomy approaches for olfactory groove meningiomas: A matched pair analysis of outcomes and frontal lobe changes on MRI.
We compare the outcomes and postoperative MRI changes of endoscopic endonasal (EEA) and bifrontal craniotomy (BFC) approaches for olfactory groove meningiomas (OGM). All patients who underwent either BFC or EEA for OGM were eligible. Matched pairs were created by matching tumor volumes of an EEA patient with a BFC patient, and matching the timing of the postoperative scans. The tumor dimensions, peritumoral edema, resectability issues, and frontal lobe changes were recorded based on preoperative and postoperative MRI. Postoperative fluid-attenuated inversion recovery (FLAIR) hyperintensity and residual cystic cavity (porencephalic cave) volume were compared using univariable and multivariable analyses. From a total of 70 patients (46 EEA, 24 BFC), 10 matched pairs (20 patients) were created. Three patients (30%) in the EEA group and two (20%) in the BFC had postoperative cerebrospinal fluid leaks (p=0.61). Gross total resections were achieved in seven (70%) of the EEA group and nine (90%) of the BFC group (p=0.26), and one patient from each group developed a recurrence. On postoperative MRI, there was no significant difference in FLAIR signal volumes between EEA and BFC approaches (6.9 versus 13.3 cm(3); p=0.17) or in porencephalic cave volumes (1.7 versus 5.0 cm(3); p=0.11) in univariable analysis. However, in a multivariable analysis, EEA was associated with less postoperative FLAIR change (p=0.02) after adjusting for the volume of preoperative edema. This study provides preliminary evidence that EEA is associated with quantifiable improvements in postoperative frontal lobe imaging.
Department of Otolaryngology, Head and Neck Surgery, Princess Margaret Cancer Center, 610 University Avenue, 3-955, Toronto, Ontario M5G 2M9, Canada. Electronic address: john.dealmeida@uhn.ca.
John R
JR
de Almeida
Division of Neurosurgery, Toronto Western Hospital, Toronto, Canada.
Felipe
F
Carvalho
Division of Neurosurgery, Standford University Medical Center, Stanford, CA, USA.
Francisco
F
Vaz Guimaraes Filho
Department of Pathology, Toronto Western Hospital, Toronto, Canada.
Tim-Rasmus
TR
Kiehl
Division of Neurosurgery, University of Louisville, Louisville, KY, USA.
Maria
M
Koutourousiou
Department of Otolaryngology, Head and Neck Surgery, MD Anderson Cancer, Houston, TX, USA.
Shirley
S
Su
Department of Otolaryngology, Head and Neck Surgery, Mount Sinai Hospital, Toronto, Canada.
Allan D
AD
Vescan
Department of Otolaryngology, Head and Neck Surgery, Mount Sinai Hospital, Toronto, Canada.
Ian J
IJ
Witterick
Division of Neurosurgery, Toronto Western Hospital, Toronto, Canada.
Gelareh
G
Zadeh
Department of Otolaryngology, Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Eric W
EW
Wang
Division of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Juan C
JC
Fernandez-Miranda
Division of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Paul A
PA
Gardner
Division of Neurosurgery, Toronto Western Hospital, Toronto, Canada.
Fred
F
Gentili
Department of Otolaryngology, Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
Carl H
CH
Snyderman
D000328:Adult; D003399:Craniotomy / Q000379:methods*; D005260:Female; D005625:Frontal Lobe / Q000473:pathology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D016555:Matched-Pair Analysis; D008577:Meningeal Neoplasms / Q000473:pathology / Q000601:surgery*; D008579:Meningioma / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D044583:Neuroendoscopy / Q000379:methods*; D016896:Treatment Outcome
Bifrontal craniotomy; Endoscopic endonasal approach; Frontal lobe injury; Olfactory groove meningioma