Olfactory preservation during anterior interhemispheric approach for anterior skull base lesions: technical note

• Published in: Neurosurgical review 2016-01, Vol.39 (1), p.63-69
• Main Authors: Matano, Fumihiro, Murai, Yasuo, Mizunari, Takayuki, Tateyama, Kojiro, Kobayashi, Shiro, Adachi, Koji, Kamiyama, Hiroyasu, Morita, Akio, Teramoto, Akira
• Format: Article
• Language: English
• Subjects: Adult; Aged; Craniopharyngioma - pathology; Craniopharyngioma - surgery; Craniotomy; Female; Fibrin; Gelatin; Humans; Intracranial Aneurysm - pathology; Intracranial Aneurysm - surgery; Male; Medicine; Medicine & Public Health; Meningioma - pathology; Meningioma - surgery; Middle Aged; Neurosurgery; Neurosurgical Procedures - adverse effects; Neurosurgical Procedures - methods; Olfaction Disorders - epidemiology; Olfaction Disorders - etiology; Olfaction Disorders - psychology; Olfactory Nerve Injuries - etiology; Olfactory Nerve Injuries - psychology; Original Article; Postoperative Complications - epidemiology; Postoperative Complications - psychology; Skull Base - surgery; Skull Base Neoplasms - surgery; Smell; Young Adult
• ISSN: 0344-5607; 1437-2320
• DOI: 10.1007/s10143-015-0647-x

Anosmia is not a rare complication of surgeries that employ the anterior interhemispheric approach. Here, we present a fibrin-gelatin fixation method that provides reinforcement and moisture to help preserve the olfactory nerve when using the anterior interhemispheric approach and describe the results and outcomes of this technique. We analyze the outcomes with this technique in 45 patients who undergo surgery for aneurysms, brain tumors, or other pathologies via the anterior interhemispheric approach. Anosmia occurred in 4 patients (8.8 %); it was transient in 2 (4.4 %) and permanent in the remaining 2 (4.4 %). Brain tumors clearly attached to the olfactory nerve were resected in the patients with permanent anosmia. We found a significant difference in the presence of anosmia between patients with or without lesions that were attaching the olfactory nerve ( p  = 0.011). Our results suggested that fibrin-gelatin fixation method can reduce the reported risk of anosmia. However, the possibility of olfactory nerve damage is relatively high when operating on brain tumors attaching olfactory nerve.