Minimally Invasive Unilateral Supraorbital Approach for Large and Giant Olfactory Groove Meningiomas.

OBJECTIVE: This study evaluated the surgical efficacy, complication profile, functional outcomes, and cosmetic success of the unilateral supraorbital mini-craniotomy approach in the treatment of large and giant olfactory groove meningiomas. METHODS: In this retrospective study, 20 patients were evaluated. Preoperative clinical and radiological characteristics, details of the surgical technique, Simpson resection grade, complications, postoperative functional status, olfactory function, and follow-up outcomes were examined. All patients were operated using a similar surgical strategy, in which brain relaxation was achieved through cerebrospinal fluid drainage in order to maintain minimal frontal lobe retraction. RESULTS: Simpson Grade 1-2 resection was achieved in the majority of cases (18 patients), whereas planned Simpson Grade 3 resection was performed in two patients due to significant comorbidity. The overall complication rate was 5%, with syndrome of inappropriate antidiuretic hormone secretion (SIADH) occurring in only one case, which resolved completely with medical treatment. No cerebrospinal fluid fistula, infection, or permanent neurological deficit was observed. In ten patients who were anosmic or had reduced olfactory function preoperatively, postoperative olfactory function remained unchanged, whereas postoperative olfactory decline was observed in a limited number of patients with preserved preoperative olfactory function. From a cosmetic standpoint, the short incision aligned with the eyebrow and the minimal bone window provided high aesthetic satisfaction among patients. CONCLUSION: Unilateral supraorbital mini-craniotomy is a safe, effective, and low-morbidity minimally invasive approach for the surgical treatment of large and giant olfactory groove meningiomas. High resection rates, a low complication profile, short recovery time, and favorable cosmetic outcomes constitute the major advantages of this technique. Larger, prospective studies will contribute to a more comprehensive evaluation of the long-term oncological and functional outcomes of this approach.