Presentation and patterns of late recurrence of olfactory groove meningiomas

The objective of this article is to present the recurrence pattern of olfac tory groove meningiomas after surgical resection. Pour patients, one female and three males, with surgically resected olfactory groove: meningiomas pr esented with tumor recurrence. All patients underwent resection of an olfac tory groove meningioma and later presented with recurrent tumors, The mean age at initial diagnosis was 47 years. All presented initially with vision changes, anosmia, memory dysfunction,and personality changes. Three patient s had a preoperative MRI scan. All patients had a craniotomy, with gross to tal resection achieved in three, and 90% tumor removal achieved in the four th. Involved dura was coagulated, but not resected, in all cases. Three pat ients were followed with routine head CT scans postoperatively, and none wa s followed with MRI scan. The mean time to recurrence was 6 years. Three pa tients presented with recurrent visual deterioration, and one presented wit h symptoms of nasal obstruction. Postoperative CT scans failed to document early tumor recurrence, whereas MRI documented tumor recurrence in all pati ents. Tumor resection and optic nerve decompression improved vision in two patients and stabilized vision in two. Complete resection was not possible because of extensive bony involvement around the anterior clinoid and infer ior to the anterior cranial fossa in all cases. Evaluation of four patients with recurrent growth of olfactory groove meningiomas showed the epicenter of recurrence to be inferior to the anterior cranial fossa, with posterior extension involving the optic canals,. leading to visual deterioration. Th is location led to a delay in diagnosis in patients who were followed only with routine CT scans. Initial surgical procedures should include removal o f involved dura and bone, and follow-up evaluation should include formal op hthalmologic evaluations and routine head MRI scans.