Topographic Patterns of Recurrence of Olfactory Groove Meningiomas After Transcranial Approach.

Background: Olfactory groove meningiomas may recur up to 30% of cases. This study focused on the topographic patterns and location of the recurrences and their surgical management.

Methods: Data on topography of recurrences from a single-center surgical series of olfactory groove meningiomas were retrospectively reviewed and analyzed along with data from pertinent literature. Analyzed factors included patient age and sex; extent of resection and management of infiltrating dura and skull base at initial surgery; time to recurrence; clinical presentation at recurrence; size, location, and histology of recurrent tumors; and management of recurrent tumors.

Results: Overall sample included 33 patients, 4 from our series and 29 from the literature. The main reported symptoms at recurrence were visual function deterioration (67%), nasal obstruction (41%), and headache (40%). The recurrent tumor involved the skull base in all cases (100%). Intracranial regrowth and sinus invasion were observed in 84% of cases. Surgery was performed mainly through the same transcranial approach (76%) or combined transcranial-transnasal approach (17%). Although Simpson grade I resection was possible in more than half of patients, a residual intradural tumor (Simpson grade IV) was left in one third.

Conclusions: Recurrences of olfactory groove meningiomas treated by transcranial approach mainly occur at the cranial base, bone, paranasal sinuses, and optic canals. This suggests resecting at the initial surgery the involved dura and bone to decompress the optic pathways. Reoperation should attempt gross total resection, at least in cases with more limited bone invasion.