Recurrence of olfactory groove meningiomas

Fayez Obeid, Ossama Al-Mefty
Neurosurgery 2003, 53 (3): 534-42; discussion 542-3

OBJECTIVE: Despite apparent gross total resection, olfactory groove meningiomas have a high rate of late recurrence (average, 23%). In this retrospective study, we confirmed that the sites of these recurrences are the cranial base and paranasal sinuses. We postulated that these recurrences stem from conservative handling of the underlying invaded bone. Therefore, we analyzed patient outcomes according to the radicality of surgical resection.

METHODS: Fifteen consecutive patients with a diagnosis of olfactory groove meningioma were treated surgically between 1992 and 2001 (nine new cases, six recurrent). Only patients with benign meningiomas were included; atypical and malignant meningiomas were excluded. Surgical resection included the dura and drilling of the underlying bone and resection of involved mucosa. We reviewed each patient's clinical records, radiological studies, sites of recurrence, grade of previous resection, and complications.

RESULTS: Olfactory groove meningiomas invaded the underlying bone in 13 cases. All patients with recurrence had previously undergone a surgical resection corresponding only to Simpson Grade 2, which does not include the removal of underlying invaded bone. The sites of recurrence were in the cranial base or adjacent paranasal sinuses. The time to recurrence varied from 1 to 12 years (average, 7 yr; mean, 8 yr). Three patients had undergone one previous resection, two had undergone two previous resections, and one had undergone four previous operations. The ethmoid sinus was involved in all cases of recurrence, either with the sphenoid sinus or with an intracranial recurrence. Thirteen patients underwent complete resection of underlying bone and the invaded paranasal sinuses, then reconstruction of the anterior fossa. No patient died. There were three instances of cerebrospinal fluid leakage (one requiring operative repair), one case of delayed worsening vision after initial improvement, and two cases of transient cranial nerve palsy (Cranial Nerves III and IV). There was no recurrence at follow-up (average, 3.7 yr; range, 1-7.3 yr).

CONCLUSION: The cranial base and paranasal sinuses are sites of predilection for recurrence of olfactory groove meningiomas. Recurrence is the result of a direct extension attributable to incomplete resection of involved bone and regrowth at the edge of a previous surgical field. Extensive resection of all suspicious underlying bone is a complement to radical removal of these lesions. Reconstruction with a vascularized pericranial flap to prevent cerebrospinal fluid leakage is crucial.

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