The Use of the Bifrontal Interhemispheric Approach with Bilateral Olfactory Tract Preservation for the Surgical Resection of Tuberculum Sella Meningiomas

Objective: Is to examine the details of the bifrontal interhemispheric approach with olfactory tract preservation; when the approach is used for surgical resection of tuberculum sella meningiomas. Material and Methods: In the period between June 2009 and January 2011, 8 patients with tuberculum sella meningiomas were operated using a bifrontal interhemispheric approach with olfactory tract preservation. All patient information were prospectively collected and at the end of the study retrospectively analyzed. Patients were followed-up for a period ranging from 6 months to 2 years. Results: Gross total resection was achieved in all cases. All cases were WHO grade 1-11 meningiothelial meningiomas. No recurrences were reported over a 2 year follow-up period. 75% of cases showed some degree of visual improvement after surgery, while 25% remained the same. 25% developed a permanent anosmia. 37.5% of cases showed variable degrees of venous infarction after surgery. However; only one case required a decompressive craniectomy. Conclusion: Bifrontal interhemispheric approach can be considered superior to any other approach regarding anatomical exposure, midline orientation, neurovascular dissection, higher incidence of radical resection and arachnoid preservation. However, the benefits of the approach must be weighed against the high incidence of venous infarction reported with this approach.