Postoperative Brain Swelling after Resection of Olfactory Groove Meningiomas.

Song, Sang Woo; Park, Chul Kee; Paek, Sun Ha; Kim, Dong Gyu; Jung, Hee Won; Chung, Young Seob

Original Article

Journal of Korean Neurosurgical Society 2006;40(6): 423-427.

Sang Woo Song, Chul Kee Park, Sun Ha Paek, Dong Gyu Kim, Hee Won Jung, Young Seob Chung

Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea. yschung@snu.ac.kr

ABSTRACT

OBJECTIVE
Postoperative brain swelling after resection of olfactory groove meningiomas by bifrontal interhemispheric transbasal approach is a knotty subject. Pathogenesis and predictive factors were investigated to prevent the problem.
METHODS
Eighteen patients of olfactory groove meningiomas who had undergone surgery were enrolled and retrospectively analyzed using their clinical and radiological data. Bifrontal interhemispheric transbasal approach was used in all patients. Magnetic resonance imaging and transfemoral cerebral angiography were available for investigation in 18 and 14 patients respectively. Postoperative clinical course, tumor volume, peritumoral edema, tumor supplying vessels, and venous drainage patterns were carefully investigated in relation to postoperative brain swelling.
RESULTS
Seven patients (39%) developed clinically overt brain swelling after surgery. Among them, 4 patients had to undergo decompression surgery. In three patients, attempted bone flap removal was done by way of prevention of increased intracranial pressure resulted from intractable brain swelling and two of them eventually developed brain swelling which could be recovered without sequellae. Abnormal frontal base venous channel observed in preoperative angiography was significant predictive factor for postoperative brain swelling (p=0.031). However, tumor volume, peritumoral edema, and existence of pial tumor supplying vessels from anterior cerebral arteries were failed to show statistical significances.
CONCLUSION
To prevent postoperative brain swelling in olfactory groove meningioma surgery, unilateral approach to preserve frontal base venous channels or temporary bone flap removal is recommended when it is indicated.

Key Words: Olfactory groove meningioma; Postoperative complication; Brain edema; Cerebral veins