title: Transfrontal-Sinus-Subcranial Approach to Olfactory Groove Meningiomas: Surgical Results and Clinical and Functional Outcome in a Consecutive Series of 21 Patients.
abstract: BACKGROUND
  The transfrontal-sinus-subcranial approach (TFSSA) allows for direct exposure and removal of olfactory groove meningiomas (OGMs), without any brain retraction. Compared with other skull base approaches (e.g., fronto-orbitobasal, transbasal, subcranial, fronto-orbitozygomatic, and one-and-half approach), it could offer the same advantages but is less invasive.
  
  
  OBJECTIVE
  We report the results in a series of 21 consecutive patients with OGMs and operated on through TFSSA, to propose a viable alternative approach.
  
  
  METHODS
  Mean maximum tumor diameter was 45.9 ± 3.4 mm (range, 25-70 mm). The aim of surgery was Simpson grade I removal. Surgical, clinical, and functional outcomes were reported. Mean follow-up was 87 ± 7 months (range, 36-176 months).
  
  
  RESULTS
  In all patients, magnetic resonance imaging after surgery confirmed complete tumor removal. The recurrence-free survival rate was 100% and 85.7% at 5 and 10 years, respectively. Surgery-related mortality and major morbidity were 0% and 4.8%, respectively. Risk of anosmia significantly correlates with meningioma size (P < 0.001) and smell sense was preserved only in patients with tumors less than 4 cm in maximum diameter (4/7; 57.1%). A significant improvement of Mini Mental Standard Examination score was recorded at follow-up (P < 0.001) and no patients worsened their cognitive profile. Visual function improved in 7/8 (87.5%). Karnofsky Performance Scale score after surgery significantly increased (P < 0.001). According to the Glasgow Outcome Score, good outcome was achieved in 20 patients (95.2%).
  
  
  CONCLUSIONS
  Based on reported results, TFSSA allows complete tumor removal with good outcome and low complication rate. It may be proposed as a safe and effective approach to treat large and giant OGMs.
authors.affiliation: Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy.
authors.forename: Lina Raffaella
authors.initials: LR
authors.lastname: Barzaghi
authors.affiliation: Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy. Electronic address: spina.alfio@hsr.it.
authors.forename: Alfio
authors.initials: A
authors.lastname: Spina
authors.affiliation: Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Gagliardi
authors.affiliation: Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Boari
authors.affiliation: Department of Neurosurgery and Gamma Knife Radiosurgery, San Raffaele Scientific Institute and Vita-Salute University, Milan, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Mortini
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000639:trends; D008297:Male; D008577:Meningeal Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D008579:Meningioma / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D008875:Middle Aged; D010256:Paranasal Sinuses / Q000000981:diagnostic imaging / Q000601:surgery*; D019291:Skull Base / Q000000981:diagnostic imaging / Q000601:surgery*; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
keywords: Anterior cranial base; Meningiomas; Olfactory groove; Skull base surgery; Surgical outcome