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09-SEPTEMBER-2019 ZAINAB ABDALLA WADI 51 YEARS
PROGRESSING OLFACTORY GROOVE MENINGIOMA.
Anamnesis
The patient came to the clinic 15-Sptember-2018
complaining of absence attacks for 2 years
every week with tonic-clonic generalization
happening the last month. MRI of the brain bad
quality performed 04-April-2018 was not
informative and EEG 20-September-2016 confirming
right temporal lobe sharp activity. On
examination at that time, she had bilateral
anosmia with tinnitus left ear. The patient is a
known diabetic for 2 years and hypertensive for
3 years and cath done 6 months ago and
coagulation for arrhythmia performed. The
patient using trileptal 300 twice daily. The
patient was sent for investigations and MRI of
the brain performed 15-September -2018 showing
sinusitis with partial empty sella and olfactory
groove meningioma 13.4 mmx11.3 mm. Cardiac
evaluation was uneventful except for prescribing
blopress plus 16/12.5 once daily. The trileptal
was prescribed three times a day. It was decided
to put the patient under observation to see the
progression of the tumor.
The patient then came 07-September-2019 telling
that the absences took place 9 times during the
last year. Neurologically was the same with
bilateral anosmia.
The patient was sent for MRI evaluation , which
was performed the same day showing enlargement
of the tumor 15.4mm x 17.1mm. The tumor
enlargement was 1.78 for what it was decided to
perform surgery. Tegretol level was 0.22 for
what it was advised to increase the trileptal to
1+1+2.
Bifrontal craniotomy with
reflection of the flap to the right ear. The frontal
sinus was violated to obtain the most lower
projection to the area avoiding by that traction
injury to the brain. The dura
was opened at the most inferior edge of bony defect.
Using SONOCA 300 the tumor was totally resected with
the dural matrix near the left olfactory bulb. The
olfactory bulbs were preserved. The dura was
water-tightly closed and a piece of muscle was
embedded to the frontal sinus . Routine closure of the
wound with ready-Vac drain under the skin flap.
Smooth postoperative recovery. She was sent to the ward.
Follow Up
The patient was discharged the 6th postoperative
day with the olfactory function regaining both
sides. The histological result was that of mixed
(meningothelial+ fibrous patterns) meningioma;
WHO Grade I.
Comments
The tumor is increasing in size for what
resection is preferable.
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Leica HM500
The World's first and the only Head mounted Microscope.
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After long years TRUMPF TruSystem 7500 is running with in the neurosuite at
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SONOCA 300
The olfactory groove meningioma in frontal and Saggital projections
with contrast.
Notice: Not all operative activities
can be recorded due to lack of time.
Notice: Head injuries and very urgent surgeries are also
escaped from the plan .
