Figure 5.

A patient presented with progressive vision loss, anosmia, gait instability, and cognitive decline and was found to have a 6.8 cm olfactory groove meningioma (OGM) with expansion into the endonasal cavity. The internal carotid arteries and their branches were pushed posteriorly by the lesion. The patient underwent a pterional craniotomy for resection of the large WHO grade I OGM with a residual tumor left in the endonasal compartment. The patient had an immediate improvement in vision, with no new neurologic deficits, and was discharged home from the hospital on post-operative day 5. She also enjoyed recovery of taste/smell and gradual but full recovery of her cognition. (A) Pre-operative axial T1 MRI with contrast demonstrating a large 6.8-cm OGM with the anterior cerebral arteries (ACAs) pushed posteriorly. (B) Pre-operative coronal T1 MRI with contrast, demonstrating a large OGM with extension through the cribriform plate into the endonasal cavity. (C) Pre-operative sagittal T1 MRI without contrast, demonstrating a large OGM with endonasal extension and displacement of the ACAs posteriorly. (D–F) Post-operative axial, coronal, and sagittal T1 MRIs with contrast, respectively, demonstrating resection of the intracranial component of the large OGM, with preservation of the ACA vasculature and a residual meningioma left in the endonasal compartment to prevent the development of a cerebrospinal fluid leak.