Is Unilateral Extended Pterional Craniotomy Preferable Over Bicoronal (Bifrontal) Craniotomy in Large or Giant Olfactory Groove Meningiomas?

Abstract

Aim: Bicoronal incision and bifrontal craniotomy are commonly used for resecting large (4-6 cm) or giant ( 6cm) olfactory groove meningiomas (OGMs). Although the bifrontal approach provides good bilateral visual access to the anterior cranial fossa, it is associated with the risk of injury to the frontal bridging veins and superior sagittal sinus, infection, and CSF leakage due to the frontal sinus neighborhood.

Material and methods: This was a retrospective review of 16patients (nine men and seven women) with large and giant OGMs operated through unilateral extended pterional craniotomy between 2010 and 2022. The radiological characteristics, clinical features,and surgical outcomes were evaluated.

Results: All patients underwent surgical resection via a unilateral extended pterional approach.The mean age of patients was 62.1 years. The most common presenting symptoms were altered consciousness, seizures, headache,and anosmia. Ten (62.5%) and 6 (37.5%) patients had large (4-6 cm) and giant ( 6 cm) OGMs, respectively. The mean tumor diameter was 6.3cm (range:4-9). Simpson grade2 resection was achieved in all 16 patients.

Conclusion: Unilateral extended pterional craniotomy offers a safe and effective alternative to the bilateral coronal approach for large and giant OGMs, minimizing risks of frontal lobe retraction, brain edema, and venous infarction. This approach allows for total resection with very low morbidity and mortality rates, making it a viable surgical approach for these complex tumors.