Topographic Patterns of Recurrence of Olfactory Groove Meningiomas After Transcranial Approach.

Abstract

Background: Olfactory groove meningiomas may recur up to 30% of cases. This study focuses on the topographic patterns and location of the recurrences and their surgical management.

Methods: Data on topography of recurrences from a monoinstitutional surgical series of olfactory groove meningiomas were retrospectively reviewed and analyzed along with those from pertinent literature. Analyzed factors included patient age and sex, extent of resection and management of the infiltrating dura and skull base at initial surgery, the time to recurrence, the clinical presentation at recurrence, the size, location and histology of the recurrent tumors and their management.

Results: Overall sample included 33 patients, 4 from our series and 29 from the literature. The main reported symptoms at recurrence were visual function deterioration (67%), nasal obstruction (41%) and headache (40%). The recurrent tumor involved the skull base in all cases (100%). Intracranial regrowth and sinus invasion were observed in 84% of cases. The surgical management was performed mainly through the same transcranial approach (76%) or combined transcranial-transnasal approach (17%). Although Simpson grade I resection was possible in more than half of the patients, a residual intradural tumor (Simpson grade IV) was left in one third.

Conclusion: Recurrences of olfactory groove meningiomas treated by transcranial approach mainly occur at cranial base, bone, paranasal sinuses and the optic canals. This suggests resecting at the initial surgery the involved dura and bone and to decompress the optic pathways. The reoperation should attempt the gross total resection, at least in cases with more limited bone invasion.