Indocyanine green-assisted endoscopic endonasal resection of an olfactory groove meningioma with vascular involvement.

Abstract

Background: Olfactory groove meningiomas are complex anterior skull base tumors representing approximately 10% of intracranial meningiomas. These tumors may involve critical structures, including the frontal lobes, optic nerves, and anterior cerebral arteries. The endoscopic endonasal approach offers direct access to the tumor, enabling early devascularization and optic canal decompression while minimizing brain retraction. However, lateral extension into the optic canals and vascular involvement remain major challenges requiring careful intraoperative management. Intraoperative indocyanine green (ICG) angiography is a valuable adjunct to safely navigate tumors involving vascular structures.

Case description: We present the case of a 52-year-old female with a large olfactory groove meningioma causing anosmia, blurred vision in the right eye, memory loss, apathy, and personality changes. The lesion was associated with extensive bifrontal vasogenic edema and involved cortical branches of the A2 segment of the anterior cerebral arteries. The endonasal endoscopic approach was selected to allow early optic canal decompression, early tumor devascularization, and potential complete resection. In the immediate postoperative period, the patient experienced transient worsening of the right eye vision without other complications. A lumbar drain was maintained for 3 days, and the patient was discharged on postoperative day 5. At 3-month follow-up, visual function improved, and cognitive and memory functions recovered significantly. Postoperative magnetic resonance imaging demonstrated gross-total resection except for a small remnant of infiltrated dura near the right optic canal. Pathology confirmed a World Health Organization grade I meningioma.

Conclusion: The integration of microsurgical techniques with ICG angiography proved beneficial, improving vascular visualization and guiding surgical decision-making.