Olfactory nerve sparing technique for anterior skull base meningiomas: how I do it

Abstract

Background: Olfactory function preservation is a desirable objective in anterior skull base (ASB) surgery. The "infracerebral-supraolfactory nerve" corridor is presented.

Method: The technique for preserving the olfactory nerves (OlfNs) in anterior ASB meningioma removal involves the following points: deep knowledge of the ASB vascular and meningeal anatomy, precise preoperative planning, wide and sharp dissection of the OlfNs away from the frontal lobes, gravity-aided frontal lobe retraction, Gelfoam-assisted hemostasis on nervous structures, and access to the lesion through an infracerebral-supraolfactory nerve corridor.

Conclusions: This technique may be a valid option for patients affected by anterior skull base meningiomas with intact preoperative olfactory function.

Keywords: Fluorescein; Lateral supraorbital approach; Meningioma; Olfactory nerve; Planum sphenoidalis.