الفهرس 
AnatomyOnly 14 pages are availabe for public view
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Abstract
Summary
Background: The enormous development of microsurgical techniques and instrumentation together with preoperative planning using the excellent preoperative diagnostic facilities available, enables neurosurgeons to treat the olfactory groove meningioma through smaller and more specific approaches like the fronto-lateral approach. Although radical excision of such lesion with the aim of decreasing the recurrence rate makes the bilateral sub-frontal approach with its modifications as adding the removal of the orbital bar one of the main techniques for excision of this lesion in order to do radical removal of this tumour.
Objective: comparison between the fronto-lateral approach and the bilateral sub-frontal approach, their advantages, disadvantages and limitations for resection of olfactory groove meningioma.
Methods: This prospective comparative study includes thirty patients with olfactory groove meningioma. These patients were operated upon in Ain Shams University hospitals, seventeen of them via bilateral sub-frontal approach and the remaining in thirteen via lateral supraorbital (fronto-lateral approach) approach through semi-coronal skin incision behind the hair line (the technique of supraorbital craniotomy is described in detail in the thesis) in the period between February 2010 and May 2013. The selection of surgical approach was according to the surgeon preference.
Results: Our statistical results revealed that patients presented with olfactory groove meningioma who were operated via frontolateral approach had comparable results with no statistical difference to the bilateral sub-frontal approach as regard degree of resection and recurrence rates and even less incidence of post-operative hematoma, behavioral changes and especially the CSF leak. However it was of debatable results as regard the excision for tumours larger than 4 to 6cm. and if there is paranasal sinuses extension.
Conclusion: the fronto-lateral approach allows a wide, intracranial exposure for olfactory groove meningioma, in comparison to the strategy of bilateral sub-frontal approach. The fronto-lateral approach offers equal surgical possibilities with comparable or even less approach-related morbidity owing to limited exposure of the cerebral surface and minimal brain retraction. However this approach is of questionable role in large tumours and with paranasal sinuses extension.
Key words: Olfactory groove meningioma, Keyhole concept, Minimally invasive neurosurgery, Fronto-lateral approach, Bilateral sub-frontal approach