A comparative evaluation of microsurgical excision of olfactory groove meningioma through unilateral (pterional) vs Bilateral (Bifrontal-transbasal) approach

Surgical management of olfactory groove meningiomas poses significant challenges. Common microsurgical approaches often result in delayed exposure of neurovascular structures. In contrast, the pterional approach offers the advantage of early dissection of the posterior neurovascular complex. Olfactory groove meningiomas constitute 4 to 13% of all meningiomas. Surgery is the primary treatment, but the recommended extent and types of approaches vary. We conducted a retrospective review of our olfactory groove meningioma series treated with microsurgery via standard unilateral or bilateral approaches. Patient records from our department (RMLIMS, LUCKNOW) were reviewed, encompassing cases treated with unilateral or bilateral approaches. Thirty patients who underwent olfactory groove meningioma removal were included, and clinical data, radiological findings, surgical treatment, and clinical outcomes were retrospectively analyzed. A total of 30 craniotomies were performed, with 16 employing unilateral pterional approaches and 14 using bilateral transbasal approaches. Overall, gross total tumor resection was achieved in 27 cases. Postoperative complications included edema (in three patients) and hematoma (in three patients). The unilateral (pterional) approach emerges as an excellent solution for olfactory groove meningioma treatment, offering early visualization of the posterior neurovascular complex. Additionally, it enables frontal sinus preservation and minimizes excessive brain retraction.