Case Study
Complete Resection of a Complex Brain Tumor
A 61-year-old man presented to Fakeeh University Hospital with progressive cognitive deficit.
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The case
A 61-year-old man presented to Fakeeh University Hospital with progressive cognitive deficit. He had previously been treated for a form of dementia. He also complained of loss of smell and blurred vision.
More recently he developed headaches and worsening of the short-term memory. An MRI scan of the brain was performed, revealing a very large lesion of the anterior cranial fossa with about 6 cm of maximum diameter with brain edema and midline shift. The diagnosis was giant olfactory groove meningioma.
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The surgery was proposed considering the mass effect of the tumor, the brain edema and midline shift. A coronal incision was made for better cosmetic result and a sub frontal bilateral mini craniotomy was performed. The tumor was moderately vascular, important structures such as the optic nerves/chiasm/tracts, the anterior cerebral arteries and branches were completely involved. However, complete resection was achieved without damage, with microsurgical technique and intraoperative neurophysiological monitoring and neuronavigation.
The patient had a quick recovery and was mobilized with rapid improvement of headache and visual problems. He was discharged within 7 days.
Post op scan showed complete resection of the tumor.
Condition
Olfactory groove meningiomas account for 8 to 13% of all intracranial meningiomas. Giant olfactory groove meningiomas (maximum diameter ≥ 6 cm) pose special problems and the main surgical challenge in treating these lesions is to excise the tumor totally without causing mortality or morbidity.
Surgical removal is often performed through different approaches; a minimal invasive sub frontal bilateral craniotomy in case of giant olfactory groove meningioma provides a good exposition of the tumor and minimizes manipulation of frontal lobes with a good bilateral visualization of critical structure such as optic nerves and vessels. The surgery of this complex skull base tumor requires a dedicated and experienced team.
This surgery led by expert Consultant Neurosurgeon – Brain & Spine involved a team of anesthetists, ICU care specialists, post op care team, to name a few. The Surgical Institute at Fakeeh University Hospital boasts of a multidisciplinary team approach offering highest degree care to the patients.
Dr. Tommaso Tufo
Lead Consultant Neurosurgery - Brain & Spine
Fakeeh University Hospital
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