REVIEW
Introdução: Os meningiomas de goteira olfatória (OGMs) são tumores raros localizados na placa cribriforme e representam cerca de 10% dos meningiomas intracranianos. O tratamento é predominantemente cirúrgico, com as abordagens pterional e bifrontal sendo as mais comuns. Objetivo: Comparar os resultados clínicos e cirúrgicos de duas abordagens no tratamento de OGMs: craniotomia pterional e craniotomia bifrontal. Métodos: Seis pacientes com OGMs, operados entre 2023 e 2024, foram analisados, divididos em dois grupos (três por via de acesso). Foram avaliados dados clínicos, exames de imagem, grau de ressecção tumoral (grau de Simpson) e classificação histopatológica. Resultados: A ressecção total do tumor foi alcançada em 83,3% dos casos, com um caso de ressecção parcial. Todos os tumores foram classificados como grau I segundo a classificação da OMS, e nenhuma recidiva foi observada durante o acompanhamento de um ano. Um paciente faleceu devido a complicações clínicas resultantes de hospitalização prolongada. Discussão: A craniotomia pterional é eficaz para tumores menores, com menos complicações. A craniotomia bifrontal é indicada para tumores maiores ou mais invasivos, embora envolva maiores riscos, como dificuldades na preservação do nervo olfatório e complicações com os seios frontais. Conclusão: A abordagem pterional é recomendada para tumores menores, enquanto a craniotomia bifrontal é necessária para tumores maiores. A escolha depende da extensão do tumor e da experiência do cirurgião, sendo o planejamento pré-operatório cuidadoso essencial.
Introduction: Olfactory groove meningiomas (OLMs) are rare tumors located in the cribriform plate and represent approximately 10% of intracranial meningiomas. Treatment is predominantly surgical, with pterional and bifrontal approaches being the most common. Objective: To compare the clinical and surgical results of two approaches in the treatment of MGO: pterional craniotomy and bifrontal craniotomy. Methods: Six patients with MGO, operated between 2023 and 2024, were analyzed, divided into two groups (three per access route). Clinical data, imaging exams, degree of tumor resection (Simpson grade) and histopathological classification were evaluated. Results: Total tumor resection was achieved in 83.3% of cases, with one case of partial resection. All tumors were classified as grade I according to the WHO classification, and no recurrence was observed during the one-year followup. One patient died due to clinical complications resulting from prolonged hospitalization. Discussion: Pterional craniotomy is effective for smaller tumors, with fewer complications. Bifrontal craniotomy is recommended for larger or more invasive tumors, although it involves greater risks, such as difficulties in preserving the olfactory nerve and complications with the frontal sinuses. Conclusion: The pterional approach is recommended for smaller tumors, whereas bifrontal craniotomy is necessary for larger tumors. The choice depends on the extent of the tumor and the surgeon’s level of experience, with careful preoperative planning being essential.
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1Department of Neurosurgery, Hospital de Neurologia Santa Mônica, Goiânia, GO, Brazil
2Department of Medicine, Centro Universitário de Mineiros, Mineiros, GO, Brazil
3Department of Radiology, Hospital de Neurologia Santa Mônica, Goiânia, GO, Brazil
4Department of Neurosurgery, Universidade Estadual de São Paulo – UNESP, Botucatu, SP, Brazil
Received Jan 14, 2025
Corrected Feb 27, 2025
Accepted Mar 11, 2025
