Egyptian Journal of Neurosurgery Volume 31 / No.

2 / April June 2016 13-20

Original Article
Functional Outcome after Microsurgery of Giant Olfactory Groove Meningoma
Ashraf Shaker Zidan* and Mohamed Abdelbari Mattar
Department of Neurosurgery, Mansoura University, Egypt
ABSTRACT
Received:
2 January 2016
Accepted:
20 August 2016

Key words:
Giant olfactory groove
meningioma
Cognitive function
Olfaction
2016 Egyptian Journal of
Neurosurgery. All rights
reserved

Background: Olfactory groove meningiomas arise in the midline along the dura of the cribriform
plate and fronto-sphenoidal suture, accounting for approximately 10% of intracranial
Meningiomas. The most common presenting symptoms are cognitive changes, headache,
anosmia and bitemporal visual field loss. The surgical goal is gross total resection of the tumor
whenever possible. Objectives: We conducted a retrospective study of twenty three patients
with olfactory groove meningioma focused on long-term follow-up results after microsurgical
treatment as well as clinical presentation, and surgical approaches. Patients and Methods:
Clinical, radiological and surgical data in a consecutive series of twenty three patients with
surgically treated giant olfactory groove meningiomas, were retrospectively reviewed. In all
patients extensive preoperative and postoperative lateralised olfactory testing was performed
using the Sniffin Sticks test battery, a psychometric testing tool. Ophthalmological evaluation
included visual acuity, fundoscopy and visual fields while psychological evaluation included a
Mini-Mental State Examination. Data were collected before, one and 48months after surgery.
Results: the study included sixteen women and seven men (mean age 49 years). Symptoms were
mental changes in 39.1%, visual impairment in 17.3% and anosmia in 13% of the patients.
Preoperative neurological examination revealed deficits in olfaction in 71.4%, mental
disturbances in 52.1% and reduced vision in 21.7% of the cases. Surgical approaches: a bifrontal
craniotomy in ten, a pterional in three, and a unilateral frontal approach in seven. Extent of
tumour resection according to Simpsons classification system was grade I in 43.4% and grade II in
56.5% of the cases. After a mean follow up period of 18 months (range 13 years) by clinical
examination and magnetic resonance imaging (MRI), 86.3% of the patients resumed normal life
activity. Olfaction was preserved in 28.5% of patients in whom pre- and postoperative data were
available. Both Mental and visual disturbances improved by 80 % of cases. Two recurrences
(8.6%) were observed and had to be reoperated. Conclusion: Giant olfactory groove
meningiomas are a challenge for neurosurgeons. Preservation of olfaction should be attempted in
patients with normal or reduced smelling preoperatively. Improvement of preoperative cognitive
changes and visual deficits without additional neurological deficits is the main aim of surgery.
Microsurgical excision of giant olfactory groove meningiomas carries less incidence of morbidity
and mortality.

INTRODUCTION
Olfactory groove meningiomas arise in the midline
along the dura of the cribriform plate and frontosphenoidal suture, accounting for approximately 10% of
intracranialMeningiomas.1,2,3,4 While most of These
tumors occupy the floor of the anterior cranial fossa,
extending from the crista galli to the tuberculum sellae.
The most common presenting symptoms are cognitive
changes, headache, anosmia and bitemporal visual field
loss.5,6
Olfactory groove meningiomas tend to depress and
displace the optic apparatus posteriorly as they grow as
opposed to tuberculum sella meningiomas which arise
*Corresponding Author:
Ashraf Shaker Zidan MD
Department of Neurosurgery, Mansoura University,
Mansoura, 35516 , Egypt.
Email: ournour2004@yahoo.com ; Fax. 0020502267016

Egyptian Journal of Neurosurgery

from beneath the optic nerves and push them superiorly

and laterally. Several different surgical approaches are
used for resection of these meningiomas depending
upon the size and laterality of the tumor. The surgical
goal is gross total resection of the tumor whenever
possible. However, invasion of the paranasal mucosa or
en plaque extensions of tumor involvement not
detectable on preoperative imaging may also play a role
in recurrence of these tumors.7,8

PATIENTS AND METHODS

Twenty three consecutive patients with olfactory
groove meningioma diagnosis were admitted, and micro
surgically resected in our department From Jan 2009 till
Jan 2012,the medical charts; surgical records and
radiological studies were retrospectively reviewed in
these patients. Only tumors with a primary origin from
the dura of the cribriform plate were included in this
study. Lesions with a predominant dural origin from the
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Zidan and Mattar / Outcome in Giant Olfactory Groove Meningoma, Volume 31 / No. 2 / April - June 2016 13-20

planum sphenoidale, tuberculum sellae, anterior

clinoidal process or orbital roof were excluded in this
series.
As shown by preoperative MRI and confirmed
intraoperatively, the tumor was attached to the
cribriform plate, adjoining part of the planum
sphenoidale, crista galli and medial orbital roofs on both
sides in all patients. Tumors in these cases were broadbased, were larger than 6 cm in maximal diameter and
had an almost symmetric growth on both sides.
Bilateral extension of the tumor into the ethmoidal
cells was disclosed on preoperative coronal MRI in two
cases and unilateral extension in one. The meningioma
extended into the optic canal on one or both sides in five
patients, all of whom had visual disturbances
preoperatively.
Magnetic resonance imaging (MRI) was done
preoperatively for all patients to demonstrate the
relationship of the tumor with the optic nerves, chiasm,
and the anterior cerebral arteries (ACA).These vessels
were encased by the tumor in three patients.
Preoperative CT with bone algorithms, revealed a
hyperostosis of the crista galli or the cribriform platein
six and erosion of the cribriform plate in two cases. MR
angiography was performed regularl yearly in the study
period to demonstrate tumor vascularity, provide
information regarding ACA displacement.In all studied
cases, the tumor was predominantly supplied by the
anterior or posterior ethmoidal branches of the
ophthalmic artery.
Ten patients with a bilateral tumor were operated
via a bifrontal craniotomy with subsequent subfrontal
removal of the meningioma. Another three patients with
bilateral tumors; tumors were excised via a pterional
approach. The contralateral tumor part was removed
after partial resection of the falxcerebri and crista galli.
Tumors restricted to one side were resected through
a unilateral frontal approach in seven cases, via a
pterional approach in three .The floor of the anterior
cranial base was covered with a vascularized galeaperiosteal flap reinforced with sutures and sometimes
fibrin glue whenever needed (were the tumor had been
removed via a frontal craniotomy). A hyperostosis of
the crista galliand/or cribriform plate was removed by
drilling in four patients.
All patients were followed-up with clinical
examination and MRI studies one month and 2 years
after surgery. Patients were examined at one or two
year intervals based on each follow-up result.

Postoperative assessment of mental function was

availablein fifteen patients with preoperative personality
changes. Olfactory function was tested semiquantitatively before surgery and on each follow-up
examination with different odours for each nostril
separately. Preoperatively, test results were reliably
obtained in fourteen patients. In the remainder mental
changes allowed only a gross differentiation between
smelling and not smelling at best. Postoperative results
of olfactory tests were available for analysis in twelve
patients. All patients with visual disturbances had
detailed pre- and postoperative ophthalmological
investigations, including visual acuity, visual fields,
fundoscopy and intra ocular pressure measurement.

RESULTS
The study included sixteen women and seven men
(mean age 49 years). The most common presenting
symptoms were mental changes in nine patients
(39.1%), headache in five (21.7%), visual deterioration
in four (17.3%) and anosmia in three cases (13%).
The duration of symptoms was longest for mental
changes (mean 2.1years, range 4months to 8 years),
medium in duration for anosmia and headache (mean 7
months, range 315 months and mean 6 months, range 4
weeks to 1 year, respectively) and shortest for visual
disturbances and seizures (mean 1 months, range 1
week and 5months and mean 2 weeks, range 16 weeks,
respectively). The neurological examination revealed, in
order of frequency, disturbance of olfaction in ten of
fourteen patients (71.4%) that could be reliably tested,
personality changes in twelve (52.1%), and decreased
vision in five patients (21.7%), (Table 1).
Table 1. Preoperative symptoms and signs in patients with
olfactory groove meningioma
No. of
Symptom
Patients (%)
patients
Mental changes
9
39.1
Headache
5
21.7
Visual disturbance
4
17.3
Disturbance of olfaction
3
13
Dizziness
4
17.3
Seizures
3
13
Neurological signs
Disturbance of olfaction*
10
71.4

Anosmia
3
21.4

Hyposmia
7
50
Mental disturbance
12
52.1
Decreased vision
5
21.7
Papilledema
6
26
*Percentage out of 14 patients that could be tested preoperatively.

14

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Zidan and Mattar / Outcome in Giant Olfactory Groove Meningoma, Volume 31 / No. 2 / April - June 2016 13-20

Regardless of the surgical approach applied, all

meningiomas were completely resected in all patients. A
Simpson9 grade I resection was achieved in
twelvepatients,eleven had been operated through a
frontal craniotomy and one via a pterional approach.
Simpson grade II removal (The dural attachment area of
the tumor was coagulated) was achieved in
elevenpatients. In two cases where the tumor had
encroached into the optic canal, opening of the optic
canal was necessary inthese patients. The optic nerves
and chiasm were posteriorly and inferiorly dislocated by
the tumor in nine cases.
There was a clear separating arachnoid membrane
facilitating tumor removal from the optic nerve, chiasm
or ACA in all cases with intimate relationship of the
meningioma to these structures. The olfactory nerves
were grossly distorted (twelve patients) or infiltrated
(seven patients) by the tumor in 19 patients. However,
the nerves were protected by an arachnoid sheath
bilateral in three and unilateral in seven cases. At the
end of the surgical procedure the nerve was in anatomic
continuity in eight patients on one side and in three
cases bilaterally.
A normal sense of smelling was maintained in three
cases with normal olfaction preoperatively (one
operated via a bifrontal and two via a pterional
route).All patients with preoperative anosmia remained
anosmic although one olfactory tract could anatomically
be preserved in two patients and both tracts in one case.
Olfaction was preserved on one side in two patients who
were hyposmic before surgery and who were treated via
a unilateral approach for a unilateral meningioma.
A postoperative deterioration of olfaction was
found ineight patients. Two patients with a normal
preoperativesense of smell were rendered hyposmic and
three anosmic.Three patients who could smell on one
nostril preoperatively became anosmic. Loss of
olfaction was usually noted immediately after surgery.
One patient with reduced olfaction before surgery
reported amelioration in smelling postoperatively.
Twelve patients (52.1%) had mental and
personality disturbances preoperatively. In order of
frequency, short-memory deficits were present in all,
inability to concentrate in nine, lethargy and apathy in
five, confusion in two and dementia in three patients.
The presence and extent of edema on preoperative MRI,
determine the presence of mental disturbances, asnine of
twelve cases presenting with mental disturbances had
moderate or extensive peri-tumoral edema. None of the
patients with a normal mental status preoperatively
deteriorated after surgery. Postoperative psychometric
assessment was available in ten out of twelve patients
with preoperative mental deficits, (Table 2).

Egyptian Journal of Neurosurgery

Table 2: Follow-up results in patients in Postoperative

olfactory groove meningioma
Symptoms
Patient number %
Preoperative Postoperative
Mental function*

Normal
0
7(70%)

Short memory
12(100%)
2(16.6%)
deficit
10(83%)
2(16.6%)

Inconcentration
3(25%)
1(8.3%)
0

Lethergy, Apathy
2(16.6%)

Confusion
1(8.3%)
1(8.3%)

Dementia
Olfaction**

Normal
4(28.5%)
3(21.4%)
2(14.2%)

Hyposmia
7(50%)

Anosmia
3(21.4%)
6(42.8%)
Visual function

Decreased visual
5(21.7%)
1(4.3%)
acuity
2(8.6%)
1(4.3%)

1(4.3%)
* Postoperative results in 10 out of 12 patients with mental
disturbances evaluated pre-and postoperatively,
**14 patients with pre-and postoperative olfactory testing

After surgery mental disturbances improved in all

but one patient with uncomplicated postoperative
course, seven patients had normal mental function; two
had slight memory and attention deficits. All these
patients regained normal daily activity. Recovery from
mental disturbances correlated with resolution of edema
on follow-up MRI.
A trans-ethmoidal cerebrospinal fluid (CSF) leak
occurred in three patients, all being operated via a
bifrontal craniotomy. The CSF leakage was successfully
treated by lumbar drainage in two patients but
necessitated surgical repair in one case (Table 3).
Table 3: Peri-operative complications in 23 patients with
olfactory groove meningioma
Surgical
(no. of
Complication
approach
patients)
(%)*
No. of patients
10
Bifrontal
3
13%
Rhinorrhea
1
4.3%
Visual deterioration
0
CN IV paresis
1
4.3%
Venous infarction
1
4.3%
Death
2
8.6%
Recurrence
7
Unilateral
4.3%
Seizures
frontal
1
3
Pterional
1
4.3%
Hypopituitirism
1
4.3%
Rebleeding
*Percentage given of all patients in this series.

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Zidan and Mattar / Outcome in Giant Olfactory Groove Meningoma, Volume 31 / No. 2 / April - June 2016 13-20

The fistula was repaired with a galeaperiosteal flap

reinforced with sutures and fibrin glue with
unremarkable postoperative course.
Two patients had major complications. One patient
operated via a bifrontal approach had intraoperative
injury of the anterior cerebral artery (ACA) that ended
up by dependency dueto mental deterioration and
hemiparesis. The second patient had basal ganglionic
hemorrhagic infarction that resulted in severe
hemiparesis and mental deterioration three days after
surgery.
There was one postoperative death (Mortality rate:
4.3%), the patient mentioned above with hemorrhagic
infarction.
All patients were followed-up with clinical
examination and MRI studies one month and 2 years

after surgery. Patients were examined at one or two

year intervals based on each follow-up result. (Mean
follow-up 18 months, range 13 years) (Figure 1 & 2).
Of the twenty two surviving patients, nineteen
(86.3%) had resumed a normallife with either no or
minor symptoms (Karnofskyscore: 90100). two
patients (9 %) returnedto their previous level of activity
but hadmajor symptoms, i.e. decreased vision and short
memory deficits (Karnofsky score: 7080). One patient
was disabled and required permanent assistance
(Karnofsky score: 40). Vision improved inall but two
patients with preoperative visual disturbances.
Two recurrences of de novo meningiomas were
observed, 2124 months after the first surgery (Table
4). These tumors were progressive in growth and had to
be reoperated.

Table 4: Tumor recurrence in this series

Age/gende
Approach
Simpson grade
51/female
bilateral
II
49/female
bilateral
II

Site
fronto-medial ethmoidal cells
cribriform plate

16

Histology
Atypical
meningothelial

d
Fig. 1 a-d: a: pre operative CT brain, b: pre operative MRI brain T2 axial cut, c: pre operative
MRI brain with contrast axial cut, d: pre operative MRI brain with contrast coronal cut

Egyptian Journal of Neurosurgery

Zidan and Mattar / Outcome in Giant Olfactory Groove Meningoma, Volume 31 / No. 2 / April - June 2016 13-20

Fig. 2: Post operative CT brain

DISCUSSION
In a consecutive series of twenty three patients with
surgically treated giant olfactory groove meningiomas,
we conducted a retrospective study focused on longterm follow-up results after microsurgical treatment as
well as clinical presentation, and surgical approaches.
Changes of the mental status are reported as a
primary symptom in 20.771% of patients harboring an
olfactory groove meningioma. 10, 11, 12Mental and
personality changes were the most common presenting
symptoms in our study (39.1%) and were found in
52.1% of the patients on clinical examination.
In the series of Solero et al. Euphoria was seen in
59.1% of patients but was infrequently seen in other
studies including our own 12. However, an early stage of
aggressiveness which later developed into apathy has
been reported and was observed in two of our cases.
Preoperative anosmia was noted on clinical
examination in 53.8100% of patients in previous
studies.3, 12, 13, 14,15,16,17 Impaired sense of smell is rarely a
reason to consult medical advice. Decreased olfaction
was appreciated by 14 of his 29 patients, being possibly
the primary symptom in only three of them. Bakay did
not observe decreased olfaction as a presenting
symptom in his series.3
Disturbance of olfaction was the presenting
symptom in 13% of our patients and was found in71.4%
of the cases on clinical examination.
Visual impairment is a common finding, being
present
in
15.358.1%
of
the
patients
preoperatively12,16,17, 18
It was found in 17.3% of our patients on admission
and the cause was either tumor encroachment into the
optic canals, direct compression of the opticnerves and
chiasm by a large tumor or increased intracranial
Egyptian Journal of Neurosurgery

pressure due to a sizeable tumor resulting in bilateral

papilledema.19
Several investigators havebeen used with success
the bifrontal craniotomy and a subfrontal route to the
meningioma
with
opening
of
the
frontal
nasalsinus.10,11,13,20,21,22 This approach provides a good
overview ofthe anterior skull base for resection of
bilateral, broad based tumors including their dural
attachment and infiltrated bone. It gives the surgeon
access to the ethmoidal air cells or nasal cavities when
these sites are involved.
Ligation of the anterior end of the superior sagittal
sinus, usually routinely performed using this approach
seems to have an infrequent but significant risk of
producing venous infarction 23.To reduce this risk it is
important to ligate the sinus immediate beneath the
foramen caecum.Seeger has proposed a unilateral basal
approach with preservation of the superior sagittal
sinus.24 However; complications related to frontal
bridging veins are not eliminated in his exposure.
In1989, Hassler has proposed the pterional
approach, to anticipate complications from the frontal
venous system and from opening of the frontal
sinus,which was also routinely used by Yaargil .25
In Hasslers series, all operated tumors could be
completely removed and no surgical complications were
encountered.Most fatal complications reported in the
literature are caused by injury of the ACA which is
masked behind the main bulk of the tumor and is
encountered late during the frontal approach.12,26,27
No permanent complications were observed in
three cases in our series treated via the pterional
approach. This approach, however, has limitations in
tumors with gross infiltration of the anterior skull base
and tumors extending into the ethmoids and nasal
cavity.
Adequate fronto-basal repair and removal of tumor
in a deep olfactory groove is difficult without significant
frontal lobe retraction. It has to be noted, that the depth
of the cribriform plate has varied anteriorly between 1
and16mm and posteriorly between 1and 10 mm, in
anatomicstudies.15 Sekhar and Tzortzidis recommends
an extended fronto-temporal craniotomy and orbital
osteotomy(one-and-a-half approach) to minimize frontal
lobe retraction and to secure the ACA and optic nerve
early during operation.28Following this approach, the
anterior and posterior ethmoidal arteries can be ligated
to interrupt the main blood supply to the tumor.
Variant surgical approaches have been used in the
current study and the tumor could be resected
completely and successfully with each of them. A
Simpson GradeI resection, as well as repair of the
anterior cranial fossa and removal of sub basal tumor
extensions were achieved almost exclusively via the
frontal route.
As long as the lower craniotomy border is flush
with the anterior cranial floor, the retraction of the
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Zidan and Mattar / Outcome in Giant Olfactory Groove Meningoma, Volume 31 / No. 2 / April - June 2016 13-20

frontal lobes is minimized. It has to be noted that the

two recurrences observed in this series, had a previous
bifrontal approach and a Simpson Grade I resection.
Also, patients who had a subfrontal resection of
their meningioma showed most of the complications
encountered in this series (Table 3). It has to be
considered that tumors resected via a bifrontal
craniotomy were usually large and always bilateral as
well as tumors invading the ethmoids. It has to be noted
that the CSF fistulas can largely be prevented by careful
covering of the frontal cranial base after tumor
resection.11,21,26
Life-quality depends on olfaction as an important
sense. Preservation of olfaction has generally been
unsatisfactory in these tumors.23Indeed, all patients in
the current series with preoperative anosmia remained
anosmic on postoperative follow-up even though the
olfactory tract was in anatomic continuity after tumor
removal in some cases.
This included all patients with tumor extension into
the ethmoids, or gross infiltration of the skull base.
Anosmia may be caused by ischemia due to deprivation
of the blood supply to the olfactory nerves or
transaction of the fila olfactoria during surgical
manipulation.
Other causes may be degeneration of the olfactory
nerve cells by protracted compression of a slowly
growing mass lesion or frank tumor infiltration of the
structures sub serving olfaction. However, conservation
of olfaction is worth attempting in patients with normal
or reduced olfaction preoperatively.
In these cases an integral arachnoid layer and viable
olfactory structures may be recognized intraoperatively
at least on one side and thus protected. While the
olfactory system and its arachnoid cistern can usually be
defined on coronal MRI in normal subjects these
structures are masked in patients with olfactory groove
meningiomas.29
In this series, the sense of smelling was fully or
partly preserved in three patients. One patient even
reported an amelioration of his sense of smelling post
operatively which was confirmed on semi quantitative
testing. Frontal lobe retraction should be kept to a
minimum to prevent tearing of the fila olfactoria at the
level of the cribriform plate.
No difference in the rate of preserving olfaction
was observed with the various surgical approaches in
our patients. Nonetheless, a unilateral surgical approach
is preferable leaving the contralateral olfactory system
undisturbed. Also endoscopic removal of such tumors
could preserve olfaction.7
Solero and coworkers reported that only 38.3% of
their patients were mentally normal before surgery. This
figure increased to81.6% postoperatively 12. Ojeman, in
reviewing his series of 19 patients harboring an
olfactory groove meningioma found that preoperative
mental disturbances and personality changes usually
18

completely recovered after tumour removal.30In our

series theseverity of mental deficits was related to
tumour size andthe extent of bifrontal edema on T2weighted preoperative MRI. Improvement of the mental
status was observed in all but one of our patients with
an uncomplicated postoperative course. Amelioration of
mental function correlated well to the disappearance of
peri focal edema on follow-up MRI.
The records on the recurrence rate of the olfactory
groove meningioma give conflicting results. A total
removal of these tumors was achieved in 67100% in
different series.12,21Many authors have reported a very
low recurrence rate18,32,33. Ojeman had no recurrences in
his 19 patients after an average follow-up period of 4.4
years.30 Chanand Thompson observed no recurrence
with a Simpson grade I and II resection after a mean
follow-up of 9 years. Other series, however, have
reported a high recurrence rate of up to 41% at 10-years
follow-up in these tumors. 31The rate of recurrence
seems to be proportional to the time period of followup.21
Two recurrences observed in this series had a
Simpson grade II resection at first surgery and appeared
in the ethmoidal cells or cribriform plate without
evidence of intracranial tumor re-growth.
Tumor in these cases has probably invaded the
paranasal mucosa and had not been removed at first
surgery although extensive drilling of the anterior floor
had been performed in at least one of these cases.
Theseen plaque tumor extensions may not be
recognized even on high-quality preoperative MRI
because they are obscured by the brightly enhancing
mucosa after contrast administration. Recurrences may
appear after along interval after an apparent radical
removal.13 Derome and Guiot11 have found that 15% of
olfactory groove meningiomas had invaded into the
paranasal sinuses and introduced a transbasal extension
of the frontal approach for these tumors in 1972. As
pointed out by these authors extensive basal resection of
involved bone will invariably result in anosmia.
Up to our knowledge all patients with evident
tumor infiltration (hyperostosis or destruction) of the
anterior cranial fossa were already anosmic before
surgery. Therefore, removal of infiltrated bone does not
impede the functional outcome in these cases. The
follow-up period in most series, including our own is
short for this tumor entity and data on the rate of
recurrence have to be regarded as preliminary.21,30

CONCLUSIONS
Giant olfactory groove meningiomas are a
challenge for neurosurgeons preservation of olfaction
should be attempted in patients with normal or reduced
smelling preoperatively. Improvement of preoperative
cognitive changes and visual deficits without additional
neurological deficits is the main aim of surgery.
Egyptian Journal of Neurosurgery

Zidan and Mattar / Outcome in Giant Olfactory Groove Meningoma, Volume 31 / No. 2 / April - June 2016 13-20

Microsurgical excision of giant olfactory groove

meningiomas carries less incidence of morbidity and
mortality.
Declaration
The author(s) declare no conflict of interest or any
financial support and confirm the approval of the
submitted article by the concerned ethical committee.

REFERENCES
1.

2.

3.
4.
5.

6.
7.

8.

9.
10.
11.

12.

13.

Al-Mefty O: Tuberculumsellae and olfactory

groove meningioma. In: Sekhar LN, Janecka IP
(eds) Surgery of cranial base tumors. Raven, New
York 507519, 1993
Al-Mefty
O,
Smith
R:
Tuberculumsellaemeningiomas. In: Al-Mefty O (ed)
Meningiomas Raven, New York 395411,
630,1991
Bakay L: Olfactory meningiomas. The missed
diagnosis. JAMA 251 1:5355, Jan 6,1984
Hentschel S, DeMonte F: Olfactory groove
meningiomas. Neurosurg Focus 14:e4,2003
Bassiouni H, Asgari S, Stolke D. Olfactory groove
meningiomas: functional outcome in a series
treated microsurgically. Acta Neurochir; 149:10921,2007
Nakasu S, Fukami T, Nakajima M, et al. Growth
pattern changes of meningiomas: long-term
analysis. Neurosurgery 56: 946- 55, 2005
Maria Koutourosiou, Juan C. FernandesMirandaeric W. Wang, Carl H. Snydreman, MBA.,
and Paul A. Gardner: Endoscopic endonasal
surgery for olfactory groove meningomas: outcome
and limitations in 50 patients. Neurosurg focus
37:E8 1-15 ,2014
Rubin G, Ben David U, Gornish, et al.
Meningiomas of the anterior cranial fossa floor.
Review of 67 cases. ActaNeurochir (Wein). 129:
26-30,1994
Simpson D: The recurrence of intracranial
meningiomas after surgical treatment. J Neurol
Neurosurg Psychiatry 20: 2239
Ojemann RG: Olfactory groove meningiomas. In:
Al-Mefty O (ed) Meningiomas. Raven Press, New
York, 383393,1991
11-Samii M, Ammirati M: Olfactory groove
meningiomas. In: Samii M (ed) Surgery of the
skull base: meningiomas. Springer, Berlin, 15
25,1992
Solero CL, Giombini S, MorelloG: Suprasellar and
olfactory meningiomas: report on a series of 153
personal cases. ActaNeurochir (Wien) 67: 181
194,1983
Florin Stefanescu, Liviu Ciocan, Mugurel Radoi, et
al. Large olfactory groove meningiomas: clinical
outcome considering different surgical approaches.
Romanian Neurosurgery XVIII 2, 2011

Egyptian Journal of Neurosurgery

14. Guthrie BL, Ebersold MJ, Scheithauer BW:

Neoplasms of the intracranial meninges. In:
Youmans JR (ed) Neurological Surgery vol 5. 3rd
ed. WB Saunders, Philadelphia, pp 3250
3315,1990. meningiomas. Neurosurgery 25:942
947,1989
15. Jung JJ, Warren FA, Kahanowicz R.Bilateral visual
loss due to a giant olfactory meningioma..ClinicalOphathalamology 6:,339-142,2012
16. Mayfrank L, Gilsbach JM: Interhemispheric
approach for microsurgical removal of olfactory
groove meningiomas. Br JNeurosurg 10:541
545,1996
17. Roberto Pallini, Eduardo Fernandez, Liverana
Lauretti. Olfactory Groove Meningioma: Report of
99 Cases Surgically Treated at the Catholic
University School of Medicine, Rome World
Neurosurg 83:219231,2015
18. Turazzi S, Cristofori L, Gambin R, Bricolo A: The
pterional approach for the microsurgical removal of
olfactory groove meningiomas. Neurosurgery 45:
821826,1999
19. Ciurea AV1, Iencean SM, Rizea RE, Brehar
FM.Olfactory groove meningiomas: a retrospective
study on 59 surgical cases. Neurosurg Rev 352:
195-202, 2012
20. Long DM: Meningiomas of the olfactory groove
and anterior fossa. Atlas of operative neurosurgical
technique, cranial operations, Lippincott Williams
& Wilkins, Baltimore 1: 238241,1989
21. Obeid F, Al-MeftyO: Recurrence of olfactory
groove meningiomas. Neurosurgery 53:534543,
2003
22. Passagia JG, Chirossel JP, Favre JJ, Gray E, Reyt
E, Righini C, Chaffanjon P : Surgical approaches to
the anterior fossa, and preservation of olfaction.
Adv Tech Stand Neurosurg 25: 195241, 1999
23. Auque J, Civit T:Superficial veins of the brain.
Neurochirurgie 42:88108,1996
24. Seeger W: Microsurgery of the cranial base.
Springer, New York, 1983
25. Yas_argil MG: Microneurosurgery of CNS
Tumors, vol IVB. Thieme, New York, 140141,
1996
26. DeMonte F: Surgical treatment of anterior basal
meningiomas. J Neurooncol 29: 239248, 1996
27. Liu JK1, Christiano LD, Patel SK, Tubbs RS, Eloy
JA.Surgical nuances for removal of olfactory groove
meningiomas using the endoscopic endonasal
transcribriform approach Neurosurg Focus 30:2011
28. Sekhar LN, Tzortzidis F: Resection of tumors by
the frontoorbital approach. In: Sekhar LN et al (eds)
Cranial
microsurgery:
approaches
and
techniques. Thieme, New York, 6175, 1999
29. Castillo M, Mukherji SK: Magnetic resonance
imaging of the olfactory apparatus. Top
MagnReson Imaging 8:8086,1996

19

Zidan and Mattar / Outcome in Giant Olfactory Groove Meningoma, Volume 31 / No. 2 / April - June 2016 13-20

30. Ojeman RG: Supra tentorial meningiomas: clinical

features and surgical management. In: Wilkins
RH, Rengachary SS (eds) Neurosurgery,
McGraw-Hill, New York, 1: 87389, 1996

20

31. Mathiesen T, Linquist C, Kihlstreom L, Karlsson

B:
Recurrence
of
cranial
meningiomas.
Neurosurgery 39: 29,1996

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