Abstract：
OBJECTIVE There has been much debate regarding the optimal surgical approach for resecting olfactory groove meningiomas (OGMs). In this paper, the authors analyzed the factors involved in approach selection and reviewed the surgical outcomes in a series of OGMs. METHODS A retrospective review of 28 consecutive OGMs from a prospective database was conducted. Each tumor was treated via one of 3 approaches: transbasal approach (n = 15), pure endoscopic endonasal approach (EEA; n = 5), and combined (endoscope-assisted) transbasal-EEA (n = 8). RESULTS The mean tumor volume was greatest in the transbasal (92.02 cm3) and combined (101.15 cm3) groups. Both groups had significant lateral dural extension over the orbits (transbasal 73.3%, p < 0.001; combined 100%), while the transbasal group had the most cerebral edema (73.3%, p < 0.001) and vascular involvement (66.7%, p < 0.001), and the least presence of a cortical cuff (33.3%, p = 0.019). All tumors in the combined group were recurrent tumors that invaded into the sinonasal cavity. The purely EEA group had the smallest mean tumor volume (33.33 cm3), all with a cortical cuff and no lateral dural extension. Gross-total resection was achieved in 80% of transbasal, 100% of EEA, and 62.5% of combined cases. Near-total resection (> 95%) was achieved in 20% of transbasal and 37.5% of combined cases, all due to tumor adherence to the critical neurovascular structures. The rate of CSF leakage was 0% in the transbasal and combined groups, and there was 1 leak in the EEA group (20%), resulting in an overall CSF leakage rate of 3.6%. Olfaction was preserved in 66.7% in the transbasal group. There was no significant difference in length of stay or 30-day readmission rate between the 3 groups. The mean modified Rankin Scale score was 0.79 after the transbasal approach, 2.0 after EEA, and 2.4 after the combined approach (p = 0.0604). The mean follow-up was 14.5 months (range 1-76 months). CONCLUSIONS The transbasal approach provided the best clinical outcomes with the lowest rate of complications for large tumors (> 40 mm) and for smaller tumors (< 40 mm) with intact olfaction. The role of EEA appears to be limited to smaller, appropriately selected tumors in which olfaction is already absent. EEA also plays an important adjunctive role when combined with the transbasal approach for recurrent OGMs invading the sinonasal cavity. Careful patient selection using an individualized, tailored strategy is important to optimize surgical outcomes.
摘要：
目的关于切除嗅沟脑膜瘤（OGMs）的最佳手术方法存在很多争论。在本文中,作者分析了与方法选择有关的因素，并回顾了一系列OGM的手术结果。方法对来自前瞻性数据库的28个连续OGM进行了回顾性回顾。每个肿瘤都通过3种方法之一进行治疗：经基底入路（n=15），单纯内镜经鼻入路（EEA；n=5），联合（内窥镜辅助）经基底EEA（n=8）。结果经基底(92.02cm3)和联合(101.15cm3)组的平均肿瘤体积最大。两组在眼眶上都有显著的外侧硬脑膜延伸(跨基底73.3%，p<0.001；组合100%)，而经基底组脑水肿最多(73.3%，p<0.001)和血管受累(66.7%，p<0.001)，皮质袖带的存在最少(33.3%，p=0.019)。合并组中所有肿瘤均为侵入鼻腔的复发性肿瘤。纯EEA组的平均肿瘤体积最小（33.33cm3），都有皮质袖带，没有外侧硬脑膜延伸。在80％的经基底组织中实现了大体全切除，100%的EEA，合并病例的62.5%。在20％的经基底和37.5％的合并病例中，几乎全部切除（>95％）。都是由于肿瘤粘附在关键的神经血管结构上。经基底组和联合组的脑脊液漏出率为0%，EEA组有1次泄漏（20%），导致CSF整体渗漏率为3.6%。跨基底组中保留了66.7％的嗅觉。3组之间的住院时间或30天再入院率没有显着差异。经基底入路后，平均改良Rankin量表评分为0.79，EEA后2.0，和2.4后的组合方法(p=0.0604)。平均随访时间为14.5个月（范围1-76个月）。结论对于大肿瘤（>40mm）和较小肿瘤（<40mm）且嗅觉完整，经基底入路可提供最佳临床结局，并发症发生率最低。EEA的作用似乎仅限于较小，适当选择嗅觉已经缺失的肿瘤。EEA与经基底入路联合治疗复发性OGM侵入鼻窦腔也起着重要的辅助作用。仔细选择患者使用个性化，量身定制的策略对于优化手术结局很重要。
