Frontolateral Approach for Resection of Giant Olfactory Groove Meningiomas

Objective: Olfactory groove meningiomas (OGMs) are a rare subtype of meningioma located in the anterior cranial fossa. Giant OGMs, defined as OGMs with a maximum length >6cm, are of particular clinical relevance due to their increased risk of frontal lobe, optic nerve, and optic chiasm compression. Given these potential complications, effective surgical management is critical. This study evaluates the efficacy of microsurgical resection of giant OGMs using the frontolateral approach. We aim to compare the outcomes of this approach to the traditional bifrontal and pterional craniotomies commonly cited in literature for the resection of giant OGMs. Methods: We retrospectively reviewed patients with giant OGMs (>6 cm) who underwent microsurgical resection between 2013–2025 across our hospital system. Clinical data, meningioma characteristics, operative findings, degree of Simpson resection, and post-operative complications were identified and analyzed. Results: 128 patients who underwent surgical resection of meningioma were identified; of those, 18 had a giant OGM (Grade 1/2/3/unknown - 9/6/2/1). The average age was 65 years old, 7 were male. Bicoronal (bifrontal) craniotomy was performed in 8 patients, pterional (frontotemporal; 3 left, 1 right) in 4 patients, and frontolateral (4 left, 2 right) in 6 patients. Gross total resection was achieved in all but one frontolateral case, which required subtotal resection. No major new or worsening post-surgical functional impairments were observed with any approach. Conclusion: We propose the frontolateral approach as a safe and effective alternative to bifrontal and pterional craniotomies for the removal of giant OGMs. It provides excellent visualization of critical neurovascular structures, facilitates gross total resection in the majority of cases, and is associated with a low incidence of complications. Publication History Article published online: 27 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany