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Giant Olfactory Groove Meningioma

July 29, 2016

Transcript

Here is another case of olfactory groove meningioma, this is a 45-year-old female who presented with progressive personality change. She was found to have a very large olfactory groove meningioma. You can see the location of the ACA branch is more posteriorly. In addition, a portion of the tumor had eroded or grown through the anterior cranial base into their nasal cavity and ethmoid sinuses. I plan to remove just the intracranial portion of the tumor and leave the portion of the tumor within the sinus intact. The portion of the tumor that was left behind after this surgery has not changed over a five-year follow-up. Patient underwent a right front temporal or pterional craniotomy. You can see the brain was quite swollen because of the presence of edema. First important step is devascularization of the tumor along the anterior skull base. You can see the floor. Following devascularization, the tumor was aggressively debulked. Aggressive devascularization controls the bleeding significantly during tumor debulking. After the tumor was debulked, the capsule was rolled away from the brain. The lateral trajectory through the pterional craniotomy provides early visualization of the cerebrovascular structures, posterior to the tumor capsule. You can see the optic nerve that has been dissected from a tumor capsule under direct vision. Here's the location of the nerve. There is evidence of peel invasion of the frontal lobe as expected based on significant edema within the frontal lobe on the preoperative MRI scan. Here's further dissection of the tumor capsule that had invaded the optic canal. Here's the optic apparatus and the chiasm. The arachnoid membranes are left intact. We are moving the tumor that had herniated through the optic canal. Again, the optic nerve. This time on the left side, smaller vein was sacrificed. Again, the left optic nerve, right optic nerve, removal of the tumor without any residual. Frontal lobe that was invaded by the tumor. Here's the carotid artery on the right, optic nerve on the right, optic nerve on the left. I opened the falciform ligament on the left side, make sure that the optic nerve is thoroughly decompressed and there's no evidence of tumor herniation through the foramen of the optic nerve. Inspection revealed small amount of tumor within the foramen on the left that was removed. Next, the area of the dura that was affected by the tumor was aggressively curated away. You can see the nerve is decompressed within its foramen. Next, the right optic nerve was inspected and the falciform ligament was opened and the tumor was removed within this foramen as well. Finally, the dura of her anterior cranial base was heavily coagulated to minimize the future risk of recurrence. Here's the post-operative MRI scan, you can see the intracranial portion of the tumor was aggressively removed, however, the portion of the tumor within the nasal cavity has remained intact, and as mentioned previously, this portion of the tumor has remained stable in five years follow-up. Thank you.

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