Name:
10.3171/2025.10.FOCVID25173_vid
Description:
10.3171/2025.10.FOCVID25173_vid
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Duration:
T00H07M05S
Embed URL:
https://stream.cadmore.media/player/913a855d-1429-4f61-b1d0-a2871df08649
Content URL:
https://cadmoreoriginalmedia.blob.core.windows.net/913a855d-1429-4f61-b1d0-a2871df08649/4. 25-173.mp4?sv=2019-02-02&sr=c&sig=0fnweCfCouYt8PBJAt7IeTb6T43Mac4zxDfNGOBHM5M%3D&st=2026-04-05T02%3A09%3A06Z&se=2026-04-05T04%3A14%3A06Z&sp=r
Upload Date:
2026-04-05T02:34:47.1134563Z
Transcript:
Language: EN.
Segment:0 .
[MUSIC PLAYING]
SPEAKER: This is the case of a 41-year-old female patient with an incidental finding of an olfactory groove meningioma that has grown in follow-up. The patient has intact olfaction. We can see here the imaging findings showing a medium-sized olfactory groove meningioma with no significant brain swelling. We discussed all the potential alternatives. The approaches that can be used for this particular lesion will include the endoscopic endonasal approach, which we do not favor in this case because of the large skull base defect that we'll create, and the sacrifice of the sense of smell.
SPEAKER: We can discuss the transnasal approach, which would also likely sacrifice the sense of smell and is more invasive approach than the alternative pterional orbitozygomatic, or frontolateral approaches. In this particular case, we're going to employ what we call a frontolateral approach, which can be done through an eyebrow incision or through a scalp incision behind the hairline, which is where we chose in this particular case.
SPEAKER: This frontolateral or supraorbital approach provides direct access to the anterior skull base and allows the transsection of the falx to access the contralateral side, aiming to preserve the sense of smell in this particular case by preserving the contralateral olfactory tract. And that's why we chose this particular approach in this case. We can discuss some of the key anatomy of the carotid system, olfactory tract, olfactory sulcus, the area of the cribriform plate, the falx, and the relationship of the falx with olfactory bulb.
SPEAKER: We describe the setup with the basic supine position with head rotated approximately 30 degrees to the contralateral side, and with a lot of extension to facilitate gravity retraction of the frontal lobes. Simple craniotomy avoiding the frontal sinus. We did not remove the roof of the orbit, but it's a medially extended frontal craniotomy with a suprafrontal approach. Intradurally, we access the cisterns, the opticocarotid cistern is accessed early on.
SPEAKER: This greatly relaxes the frontal lobe, which allowed doing this operation without the need for any fixed retraction. The brain is nicely protected with cottonoids. We can start seeing the implantation of the tumor into the anterior skull base, and we of course start devascularizing the tumor at its base. As we can see here, we can very easily access the falx, coagulate any potential falcine branches coming from the area.
SPEAKER: We can see the right olfactory tract-- it is very stretched by the tumor. We do not intend to preserve this olfactory tract, so we sacrifice it upfront. This allowed us to get excellent access to the tumor. We can see the right olfactory bulb. Again, we do not try to preserve olfaction in this side, but our aim is to preserve the contralateral olfactory nerve. By coagulating the olfactory bulb, we can access the ipsilateral olfactory sulcus and make sure that it is completely clean of tumor.
SPEAKER: We continue devascularizing the tumor, and then just performing the standard intracapsular debulking. Again, we avoid fixed retraction with good fluid drainage on the cisterns, and head positioning we can relax the brain nicely. Be very careful with the orbitofrontal arteries. Don't be tempted to coagulate these branches.
SPEAKER: These are still important to provide vascular supply to the fronto-orbital region, and they are not tumor branches. Although they can provide vascular supply, they can be selectively preserved. We are now coagulating and transsecting the falx, and this allows us to access the contralateral aspect of the tumor carefully, not to injure the contralateral olfactory bulb. We can now identify the falcine artery.
SPEAKER: This is now being coagulated. This is a major source of blood supply in this case. And after careful debulking, we can start identifying the contralateral olfactory nerve. We have direct access to the contralateral side. We preserve not just the olfactory nerve, but the microvascular supply to this nerve. We are now dissecting crista galli and the dura that surrounds it of the falx implantation.
SPEAKER: This allow me to get better access. I respect the arachnoid planes because again, I want to preserve the arachnoid that covers the olfactory nerve. I place a bit of Gelfoam with nicardipine to prevent vasospasm on the microvasculature of the left olfactory nerve. Again, a major goal of the operation is to preserve olfaction on the other side. And now the tumor is being detached from the contralateral arachnoid of the fronto-orbital region.
SPEAKER: We see another fronto-orbital branch, and we are meticulously dissecting and preserving. Using the arachnoid planes, we can dissect the proximal part now of the olfactory tract. Again, just to be careful in this area, preserve arachnoid planes, preserve the microvasculature. Another piece of Gelfoam with nicardipine to treat that vasculature and prevent vasospasm of the microvessels to the olfactory nerve.
SPEAKER: Last bits of tumor are stuck to that fronto-orbital branch. We're using, again, arachnoid dissection planes to fully resect the last bits of tumor that are extending towards the contralateral olfactory sulcus. We calculate the implantation of the tumor, careful not to coagulate the contralateral olfactory sulcus. The dura on the anterior skull base all the way to the cribriform plate on the patient's right side is being transected.
SPEAKER: We also drill the skull base without entering to the sinuses. The patient had no complications. Fortunately, the sense of smell was very well preserved. Patient was discharged on postoperative day 2. And this case highlights how a traditional frontolateral approach can be the best choice for this medium-sized olfactory groove meningioma, where we want to preserve the sense of smell.
SPEAKER: Thank you.
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