ENT Surgeon Case Studies

Frontal Sinus Removal of an Olfactory Groove Meningioma Using Intra-operative MRI

Patient Profile

Sixty-nine-year-old female presented with a history of increasing headaches over a six-week period and anosmia for 10 years. She previously had a right mastectomy for intra-ductal breast carcinoma in 1989. MR imaging revealed a homogeneously enhancing mass in the midline anterior fossa measuring approximately 4.0 x 3.0 x 2.5 cm. The patient was informed about the risks and benefits of surgery and she consented to a surgical resection of the lesion via a craniotomy involving bilateral frontal sinuses.

Operation

Following the placement of a lumbar drain, the patient was placed in the supine position, with the vertex pointing down, and the head was secured in the PoleStar^® N-10 head holder. A preoperative MRI was performed. A bicoronal incision was fashioned behind the hairline and pericranium was harvested. The bilateral frontal sinus was mapped out with illumination at the inner canthus and the anterior wall of the frontal sinus was removed in one piece as the bone flap to be replaced during closure. Sinuses were exenterated. The posterior wall of the sinus was removed. The frontal lobes were retracted and the lesion was identified and resected using microsurgical dissection techniques with the sacrifice of bilateral olfactory nerves (in an anosmic patient). The tumor was removed in a piecemeal fashion. The PoleStar^® N-10 intra-operative MRI was then used to confirm the gross total removal of the lesion. The frontal sinuses were cranialized and closed in a standard fashion.

Conclusion

The patient tolerated the procedure without any complications and was discharged home a few days later with no new neurological deficits.

Comments

"The use of the PoleStar^® N-10 intra-operative MRI provided on-table confirmation for the gross total removal of an olfactory groove meningioma through a narrow window of the frontal sinuses." - Johnny B. Delashaw, MD Neurosurgeon Oregon Health and Science University Portland, Oregon

NOTE: The experiences described here are specific to this particular patient. Results vary and every response is not the same. Patients should always talk with their doctors to see if they may benefit from this therapy and for a full review of indications and side effects.