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Olfactory Groove Meningioma

Meningioma of Olfactory Groove

An olfactory groove meningioma is a rare benign tumor with a rather insidious course. Most common symptoms are anosmia, headaches, and visual disturbances, but a range of manifestations, both neurologic and psychiatric, has been described in a significant number of patients. Clinical suspicion towards intracranial neoplasms must be raised when longstanding signs are present, whereas confirmation is achieved through imaging studies, such as magnetic resonance imaging (MRI), diffusion-weighted imaging (DWI), and MR spectroscopy.


Presentation

Encompassing approximately 12% of all meningiomas in the base of the skull, an olfactory groove meningioma (OGM) arises from the arachnoidal cells located in the lamina cribrosa of the ethmoid bone and frontosphenoidal suture [1] [2] [3]. One of the most important features of OGM is its frequent delay in the diagnosis due to lack of clinical suspicion despite the presence of typical symptoms and up to 3 years may pass before the condition is recognized [3] [4] [5]. Anosmia and headaches are considered to be the primary signs [1] [2] [6], but they are often misdiagnosed as sinusitis, migraines or neuralgia [6]. Moreover, visual deficits (hypophthalmos, visual acuity impairment, and vision loss), nasal obstruction, hyposmia, epistaxis, and papilledema may be seen [3]. In up to a third of cases, psychiatric complaints in the form of disinhibition, psychosis, personality changes, confusion, or even cognitive decline (eg. memory loss) are noticed [1] [3] [5] [7]. In advanced stages of tumor development, the appearance of seizures is common, whereas hemiparesis is also observed in a number of sufferers [3]. For still unknown reasons, the majority of case studies in the literature have identified a significant predominance towards female gender [1] [3] [7].

Pallor
  • Visual impairment, including optic disc swelling and pallor, was found in 45% of our patients on clinical examination.[mmj.eg.net]
Lymphadenopathy
  • There was no significant lymphadenopathy. There was no dependent oedema. Naso-pharyngeal examination did not reveal any abnormality. Respiratory system and cardiovascular system did not reveal any abnormality. The liver and spleen were not palpable.[ijo.in]
Anorexia
  • الصفحة 297 - Not present 1 Periods of sadness or guilt greater than normal, never sustained for days or weeks. 2 Sustained depression ( 1 week or more). 3 — Sustained depression with vegetative symptoms (insomnia, anorexia, weight loss, loss of interest[books.google.com]
Weight Loss
  • الصفحة 297 - Not present 1 Periods of sadness or guilt greater than normal, never sustained for days or weeks. 2 Sustained depression ( 1 week or more). 3 — Sustained depression with vegetative symptoms (insomnia, anorexia, weight loss, loss of interest[books.google.com]
Anosmia
  • Anosmia and headaches are considered to be the primary signs, but they are often misdiagnosed as sinusitis, migraines or neuralgia.[symptoma.com]
  • The patient had right-sided anosmia. Computed tomography and magnetic resonance imaging showed a lesion in the frontal lobe that was deviated to the right and attached to the olfactory groove.[ncbi.nlm.nih.gov]
  • When following up one of these patients for a period of 24 months anosmia ipsilateral to the tumour was still present. The four patients with bilateral anosmia had a large bilateral tumour, whereas all others had a lateralised tumour (table).[jnnp.bmj.com]
  • His anosmia persisted and he had diplopia on looking down after the operation. The diplopia resolved after 6 months but the anosmia remained. He has since resumed work. Figure 1.[cfp.ca]
  • When symptomatic, they can produce Foster Kennedy syndrome (anosmia, ipsilateral optic atrophy, contralateral papilledema), metal status change, urinary incontinence Histological variables follow WHO grading I to III (from low recurrence to high rates[radiologyinthai.blogspot.com]
Hyposmia
  • Moreover, visual deficits (hypophthalmos, visual acuity impairment, and vision loss), nasal obstruction, hyposmia, epistaxis, and papilledema may be seen.[symptoma.com]
  • Anosmia and hyposmia was present in 9 and 10 cases respectively. Visual disturbances was seen in 16 cases. Radiological bone changes in form of hyperostosis and bone erosion was seen in 14 cases.[journalijar.com]
  • Six patients had anosmia ipsilaterally to the tumour, four of them were completely anosmic, two had contralateral hyposmia or normosmia.[jnnp.bmj.com]
  • The time frame noted from the development of initial symptoms to the time of diagnosis varies substantially between different series and has been reported to be up to 14 years. 9 Hyposmia or anosmia is one of the earliest presenting symptoms, but few[clinicalgate.com]
  • The enigmatic origin ofsubfrontal schwannomas: report of a case without hyposmia.[docslide.com.br]
Scotoma
  • Abstract Cecocentral scotomas are a hallmark of toxic, metabolic, and hereditary optic neuropathies, but are rarely associated with compressive processes.[ncbi.nlm.nih.gov]
  • […] as one-sided optic atrophy with papilledema in the other eye but with the absence of a mass. [3] Presentation [ edit ] The syndrome is defined as the following changes: optic atrophy in the ipsilateral eye disc edema in the contralateral eye central scotoma[en.wikipedia.org]
  • Vision deficits often progress asymmetrically; the commonest early visual complaint is blurred vision in one eye secondary to a central scotoma, but partial loss of vision in one eye proceeds almost unnoticed by the patient [12].[mmj.eg.net]
Hypomimia
  • Facial Expression: 0 — Normal. 1 — Minimal hypomimia, could be normal "poker face. ‏[books.google.com]
Psychiatric Symptoms
  • The anatomic location of the olfactory groove meningioma may cause prolonged psychiatric symptoms before the onset of more overt neurologic deficits.[operativeneurosurgery.com]
  • The anatomic location of OGMs may cause prolonged psychiatric symptoms before the onset of more overt neurologic deficits. For these reasons, OGM are among the largest intracranial tumors we see [3].[mmj.eg.net]
Olfactory Hallucination
  • hallucination [医]嗅幻觉,幻嗅 olfactory islands [医]嗅岛 olfactory knob 嗅小结 olfactory lobe 嗅叶 olfactory membrane [医]嗅膜 olfactory mucosa 嗅粘膜 olfactory mucosa membrane 嗅粘膜 olfactory muscous membrane 嗅粘膜 olfactory nerve 嗅神经 olfactory nerve filament [医]嗅神经丝 olfactory[fastdict.net]
Headache
  • Anosmia and headaches are considered to be the primary signs, but they are often misdiagnosed as sinusitis, migraines or neuralgia.[symptoma.com]
  • A 55-year-old woman presented with a longstanding history of headache and personality change. Preoperative imaging suggested an olfactory groove meningioma invading the posterior nasal space.[ncbi.nlm.nih.gov]
  • A 66-year-old woman presented with a 1-year history of progressive headaches. Clinical examination revealed hypoesthesia of the nasal tip. CT-scan and MRI studies revealed a large subfrontal tumor thought preoperatively to be a meningioma.[ncbi.nlm.nih.gov]
  • Case Discussion A 69-year-old male presenting with headache for one week and diplopia. 2 public playlists includes this case Related Radiopaedia articles Meningioma Promoted articles (advertising) Case information rID: 8334 Published: 24th Jan 2010 Last[radiopaedia.org]
  • Souza et al., 2003 [15] 27, M OGS Headache Yes Cystic Homogeneous n.r.[docslide.com.br]
Foster-Kennedy Syndrome
  • We believe that this patient with olfactory groove meningioma represents a rare case of Foster Kennedy syndrome and optociliary shunt vessels.[ncbi.nlm.nih.gov]
  • Foster-kennedy syndrome in a case of olfactory-groove meningioma. Indian J Ophthalmol 1965;13:75-8 How to cite this URL: Markand O N, Chandrakar K L. Foster-kennedy syndrome in a case of olfactory-groove meningioma.[ijo.in]
  • Just saying....since that's what I have to do Gadi Medical Student Foster-Kennedy's syndrome due to olfactory groove #Meningioma . pope Medical Student Remember, Foster-Kennedy Syndrome has a very specific set of findings.[app.figure1.com]
  • When symptomatic, they can produce Foster Kennedy syndrome (anosmia, ipsilateral optic atrophy, contralateral papilledema), metal status change, urinary incontinence Histological variables follow WHO grading I to III (from low recurrence to high rates[radiologyinthai.blogspot.com]
  • The triad of anosmia and unilateral optic atrophy with contralateral papilledema first described in the Foster Kennedy syndrome is rare and can be observed in other conditions. 16 – 19 In addition to the Foster Kennedy syndrome, optociliary shunting may[clinicalgate.com]
Hand Tremor
  • The neurologist said that the tumor was not causing his hand tremors but that it must be removed before serious symptoms developed.[skullbaseinstitute.com]
Rabies
  • Surgical excision offers good outcome. [ Kumar Ashish, Guru Prasad, Kuntal K Das, Anant Mehrotra, Arun K Srivastava, Rabi N Sahu, Sushila Jaiswal, Sanjay Behari, Awadhesh Kumar Jaiswal (2015); Olfactory groove meningioma: an analysis based on 24 cases[journalijar.com]

Workup

Given the slowly progressive and underrecognized nature of OGM, it is essential to perform a comprehensive and meticulous workup. Firstly, a detailed patient history that will assess the course and progression of symptoms should be obtained, followed by a thorough physical examination, with a particular emphasis on the neurological examination. However, olfactory testing frequently yields normal findings, thus the typical clinical picture might be absent [2]. To determine the underlying etiology (but also to plan the optimal therapeutic strategy), imaging studies need to be employed. Computed tomography (CT), although sometimes sufficient to make the diagnosis [5], has shown to be of limited use in the assessment of olfactory groove meningioma (particularly in the postoperative setting when patients are checked for tumor recurrence) [4]. For this reason, MRI (sometimes with gadolinium contrast enhancement) is the recommended study, showing an isointense or slightly hypointense signaling on T1-weighted studies and a hyperintense signal on T2-weighted studies compared to the cerebral cortex in the case of OGM [3] [8]. Because meningiomas have a wide differential diagnosis, additional exams, such as diffusion-weighted imaging, diffusion tensor imaging (DT), and MR spectroscopy are frequently used to further solidify the diagnosis [8].

Treatment

  • Dramatic technological advancements have also been made in diagnostic and interventional radiology as well as in surgical and radiation treatments for meningiomas, such as incorporation of the following in the treatment armamentaria: endoscopy, various[books.google.com]
  • Treatment Available Depending on the tumor itself and your health, we consider several treatment approaches. If you have other medical conditions, we may take a conservative approach, such as frequent imaging and observation.[mountsinai.org]
  • Morbidity and mortality associated with operative treatment of olfactory groove meningiomas have improved greatly over the past 3 decades.[memyselfmeningioma.wordpress.com]
  • Conclusion: SRS provides an excellent treatment alternative for a select group of patients with OGMs who wish to maintain their sense of smell.[karger.com]
  • Packed with more than 1800 colour diagrams, illustrations and radiological images, the treatment of various neurosurgical subspecialties such as epilepsy and cerebral palsy, is also discussed.[books.google.com]

Prognosis

  • OBJECTIVE: We reviewed our series of olfactory groove meningiomas (OGMs) with the aim to relate the surgical approach with outcome and to define clinical and pathologic predictors of prognosis.[ncbi.nlm.nih.gov]
  • Tumor at the base of the frontal lobe produces inappropriate behavior, optic nerve atrophy on the side of the tumor, papilledema on the other side, and anosmia (Foster- Kennedy syndrome). [6] Treatment and prognosis [ edit ] The treatment, and therefore[en.wikipedia.org]
  • They also carry the best prognosis and a very low recurrence rate. Grade II: Atypical meningiomas come under this category. About 5% of all meningiomas belong to this grade. Tumors belonging to this grade have a high recurrence rate (about 50%).[drtbalu.co.in]
  • […] and rads are controversial rads works well (according to imaging) so do for primary and recurrent - can be fractionated or SRS chemo - salvage only doxorubicin, ifosfamide etoposide, methotrexate, cyclophosphamide, cisplatin, mitomycin, vincristine prognosis[quizlet.com]
  • Discussion Oligoastrocytomas are rare mixed gliomas that arefound most commonly in patients between 30 and 40 yearsold and are most often low-grade or "benign".Grading, on a scale of 1 to 4, is based on the predominantcell type (usually astrocytic), and the prognosis[uhnj.org]

Etiology

  • A case of acute, severe, remitting, symmetrical visual loss with cecocentral scotomas, initially thought to be of toxic etiology, proved to be due to a typical suprasellar meningioma originating in the olfactory groove.[ncbi.nlm.nih.gov]
  • To determine the underlying etiology (but also to plan the optimal therapeutic strategy), imaging studies need to be employed.[symptoma.com]
  • Meningiomas 371 Orbitosphenoid Meningiomas 379 Cavernous Sinus Meningiomas Conservative Surgical Management 389 Preoperative Embolization of Meningiomas 89 Neuroophthalmic Evaluations in Patients with Meningiomas 101 Meningioma Tumorigenesis An Overview of Etiologic[books.google.com]

Epidemiology

  • We reviewed the literature in order to establish the epidemiology of these tumors, from which there appear to be divergent profiles depending on tumor origin and histology.[ncbi.nlm.nih.gov]
  • Classification Epidemiology The incidence of olfactory groove meningioma is approximately 8%–14% of all intracranial meningioma s 4).[operativeneurosurgery.com]
  • Dueo their unusual frequency, we review the literature in order tostablish the epidemiological profile and pathogenesis of this kindf tumor..[docslide.com.br]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology: Meningiomas arise from meningothelial cap cells that are largely distributed through the arachnoid trabeculations.[drtbalu.co.in]

Prevention

  • The bone flap is secure to the skull by leaving a sufficient ridge at its inferior surface to prevent necrosis or edema of the pericranial flap. 48 Sufficient inferior fixation is also necessary to prevent the bone flap from sinking in and providing an[clinicalgate.com]
  • .: Prevention of hip fracture in elderly people with use of a hip protector. ‏[books.google.com]
  • The region of the cribriform plate is covered with a graft of pericranial tissue and Gelfoam to prevent a cerebrospinal fluid (CSF) leak.[meningiomas.org]
  • The results indicate that problems in the affective appreciation of humour and in emotionalizing (alexithymic symptoms) may be the result of damage to the ventral-rostral portions of the ACG/mPFC, which prevent the patient from assessing the salience[operativeneurosurgery.com]
  • Drilling of the cranial base does not seem necessary for preventing tumoral recurrence.[revistaneurocirugia.com]

References

Article

  1. Nakamura M, Struck M, Roser F, Vorkapic P, Samii M. Olfactory groove meningiomas: clinical outcome and recurrence rates after tumor removal through the frontolateral and bifrontal approach. Neurosurgery. 2007 May;60(5):844-852.
  2. Welge-Luessen A, Temmel A, Quint C, Moll B, Wolf S, Hummel T. Olfactory function in patients with olfactory groove meningioma. J Neurol Neurosurg Psychiatry. 2001;70(2):218-221.
  3. Pallini R, Fernandez E, Lauretti L, et al. Olfactory groove meningioma: report of 99 cases surgically treated at the Catholic University School of Medicine, Rome. World Neurosurg. 2015;83(2):219-231.e1-3.
  4. Snyder WE, Shah MV, Weisberger EC, Campbell RL. Presentation and Patterns of Late Recurrence of Olfactory Groove Meningiomas. Skull base surgery. 2000;10(3):131-139.
  5. Leo RJ, DuBois RL. A case of olfactory groove meningioma misdiagnosed as schizophrenia. J Clin Psychiatry. 2016;77(1):67-68.
  6. Tsikoudas A, Martin-Hirsch DP. Olfactory groove meningiomas. Clin Otolaryngol Allied Sci. 1999;24(6):507-509.
  7. Pepper JP, Hecht SL, Gebarski SS, Lin EM, Sullivan SE, Marentette LJ. Olfactory groove meningioma: discussion of clinical presentation and surgical outcomes following excision via the subcranial approach. Laryngoscope. 2011;121(11):2282-2289.
  8. Tamrazi B, Shiroishi MS, Liu C-SJ. Advanced Imaging of Intracranial Meningiomas. Neurosurg Clin N Am. 2016;27(2):137-143.

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Last updated: 2019-06-28 09:57