Olfactory Groove Meningiomas

Olfactory groove meningiomas represent 10% of meningiomas, and by virtue of their frontal location are typically well-accommodated early in their growth; they often present therefore as large tumours, with radiological and clinical signs of raised intracranial pressure. Surgical treatment of these tumours is assisted by the frontal location, and has encouraged a diverse set of approaches. Classically, these tumours have been resected through a wide, bicoronal subfrontal approach, although increasingly there has been a trend towards smaller openings. A pterional or modified fronto-temporal craniotomy offers a unilateral surgical corridor with distinct advantages for identifying the optic chiasm and anterior cerebral arteries early in the procedure. More recently, endoscopic techniques have been employed through both endonasal and ‘minimally invasive’ supraorbital routes. Here, we describe the salient anatomy of the olfactory groove, its radiological features and surgical considerations for each of these approaches.