Precision in Complexity: A Protocol-Driven Quantitative Anatomic Strategy for Giant Olfactory Groove Meningioma Resection in a High-Risk Geriatric Patient

Sep 30, 2026

Uploaded by Rhys

Managing large midline olfactory groove meningiomas is especially difficult in elderly patients with limited physiological reserve. The case integrates new quantifiable anatomical measurements with a structured multidisciplinary preoperative and postoperative protocol. A 68-year-old male with severe visual impairment, cognitive dysfunction, and major comorbidities underwent bifrontal craniotomy with staged ultrasonic internal decompression and microsurgical tumor removal under multimodal neurophysiological monitoring. Preoperative imaging quantification guided risk-based corridor selection, and postoperative imaging confirmed complete resection with optic apparatus decompression. Pathology showed WHO Grade I meningioma with an AKT1(E17K) mutation.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages16

Reading Time40 min

AccessFree to download

Abstract

Background/Objectives

Case Presentation

Discussion

Conclusions

Introduction

Case Report Precision in Complexity: A Protocol-Driven Quantitative Anatomic Strategy for Giant Olfactory Groove Meningioma Resection in a High-Risk Geriatric Patient Valentin Titus Grigorean 1,2,3,†, Cosmin Pantu 1,3,4, *, Alexandru Breazu 1,3,4,*, George Pariza 1,2,3,†, Octavian Munteanu 1,3,4, Mugurel Petrinel Radoi 1,3,5,6 and Adrian Vasile Dumitru 1,3,7 Academic Editor: Ali Y Mian Received: 1 December 2025 Revised: 21 December 2025 Accepted: 29 December 2025 Published: 1 January 2026 Copyright: © 2026 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license. 1 Faculty of General Medicine,“Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; [adriandumitru@umfro.com](adriandumitru@umfro.com) (A.V.D.) 2 Department of General Surgery,“Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania 3 Puls Med Association, 051885 Bucharest, Romania 4 Department of Anatomy,“Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania 5 Department of Neurosurgery,“Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania 6 Department of Vascular Neurosurgery, National Institute of Neurology and Neurovascular Diseases, 077160 Bucharest, Romania 7 Department of Pathology, Faculty of Medicine,“Carol Davila” University of Medicine and Pharmacy, 030167 Bucharest, Romania * Correspondence: [cosmin.pantu@umfcd.ro](cosmin.pantu@umfcd.ro) (C.P.); [alexandru-valeriu.breazu@umfcd.ro](alexandru-valeriu.breazu@umfcd.ro) (A.B.)† These authors contributed equally to this work. Abstract Background/Objectives: Managing large midline olfactory groove meningiomas is especially difficult in elderly patients who have limited physiological reserves. Here we describe a unique and dangerous geriatric case where we used new quantifiable anatomical measurements and developed a structured multidisciplinary preoperative and postoperative protocol to assist in all aspects of surgery. Case Presentation: A 68-year-old male with fronto-lobe syndrome and disability (astasia-abasia; Tinetti Balance Score of 4/16 and Gait Score of 0/12) as well as cognitive dysfunction (MoCA score of 12/30) and blindness bilaterally. Imaging prior to surgery demonstrated a very large olfactory groove meningioma which severely compressed both optic pathways at the level of the optic canals (up to 71% reduction in cross-sectional area of the optic nerves) and had complex vascular relationships with the anterior cerebral artery complex (210◦ contact surface) . Due to significant cardiovascular disease and liver disease, his care followed a coordinated optimization protocol for the perioperative period. He underwent bifrontal craniotomy, initial early devascularization and then staged ultrasonic internal decompression (approximately 70% reduction in tumor volume) and finally microsurgical dissection of the tumor under multi-modal monitoring of neurophysiology. Discussion: We analyzed his imaging data prior to surgery using a standardized measurement protocol to provide quantitative measures of the degree of compression of the optic pathways (traction-stretch index = 1.93; optic angulation = 47.3◦ ) . These quantitative measures allowed us to make a risk-based evaluation of the anatomy and to guide our choices of corridors through which to dissect and remove the tumor. Following surgery, imaging studies demonstrated complete removal of the tumor with significant relief of the frontal lobe and optic apparatus from compression. His pathology showed that he had a WHO Grade I meningioma with an AKT1(E17K) mutation identified on molecular profiling. Conclusions: This case is intended to demonstrate the feasibility of integrating quantitative anatomical measurements into a multidisciplinary, protocol-based perioperative pathway to maximize the safe

FAQs

What makes giant olfactory groove meningioma surgery particularly challenging in elderly patients?

Their proximity to critical neurovascular structures and the limited physiological reserves in older patients increase perioperative risk. Cognitive decline and gait impairment frequently present at diagnosis, adding complexity to management.

What quantitative measurements were used to guide surgical planning?

The protocol used standardized measurement indices to quantify optic pathway compression, including a traction-stretch index of 1.93 and an optic angulation of 47.3°.

How was the tumor removed and what were the key outcomes?

The patient underwent bifrontal craniotomy with initial early devascularization, staged ultrasonic internal decompression (about 70% volume reduction), and microsurgical dissection with multimodal monitoring. Postoperative imaging demonstrated complete tumor removal with relief of compression of the frontal lobe and optic apparatus.

Sep 30, 2026

Uploaded by Rhys