{"id":"e43848b1-88c6-4b8d-afd5-5475d3fa12cd","slug":"indocyanine-green-assisted-endoscopic-endonasal-resection-of-an-olfactory-groove-meningioma-with-vascular-involvement","title":"Indocyanine green-assisted endoscopic endonasal resection of an olfactory groove meningioma with vascular involvement","authors":["Guilherme Gago","Martin Côté","Sylvie Nadeau","Pierre-Olivier Champagne"],"abstract":"Background: Olfactory groove meningiomas are complex anterior skull base tumors representing approximately 10% of intracranial meningiomas. These tumors may involve critical structures, including the frontal lobes, optic nerves, and anterior cerebral arteries. The endoscopic endonasal approach offers direct access to the tumor, enabling early devascularization and optic canal decompression while minimizing brain retraction. However, lateral extension into the optic canals and vascular involvement remain major challenges requiring careful intraoperative management. Intraoperative indocyanine green (ICG) angiography is a valuable adjunct to safely navigate tumors involving vascular structures. Case Description: We present the case of a 52-year-old female with a large olfactory groove meningioma causing anosmia, blurred vision in the right eye, memory loss, apathy, and personality changes. The lesion was associated with extensive bifrontal vasogenic edema and involved cortical branches of the A2 segment of the anterior cerebral arteries. The endonasal endoscopic approach was selected to allow early optic canal decompression, early tumor devascularization, and potential complete resection. In the immediate postoperative period, the patient experienced transient worsening of the right eye vision without other complications. A lumbar drain was maintained for 3 days, and the patient was discharged on postoperative day 5. At 3-month follow-up, visual function improved, and cognitive and memory functions recovered significantly. Postoperative magnetic resonance imaging demonstrated gross-total resection except for a small remnant of infiltrated dura near the right optic canal. Pathology confirmed a World Health Organization grade I meningioma. Conclusion: The integration of microsurgical techniques with ICG angiography proved beneficial, improving vascular visualization and guiding surgical decision-making. 3:40 – Draf 3 Sinusotomy: After complete ethmoidectomy, the frontal sinus ostia were identified. Following frontal sinusotomy, we proceeded with Draf 3 sinusotomy to create a common frontal sinus. 5:06 – Coagulation and Transection of Ethmoidal Arteries: After the removal of the bilateral lamina papyracea, we performed coagulation and transection of the anterior and posterior ethmoidal arteries. This maneuver is essential for tumor devascularization and also allows for lateral expansion of the access to the fovea ethmoidalis through lateral retraction of the periorbita. 6:09 – Coagulation of Superior Intercavernous Sinus: We made an incision in the dura mater at the sellar dura below the superior intercavernous sinus and another incision above it in the suprasellar dura. Subsequently, we proceeded with the coagulation and transection of the intercavernous sinus. This maneuver is critical for connecting the sellar region with the suprasellar region, both occupied by the tumor. 7:35 – Indocyanine green (ICG) – Tumoral Feeder: After intraoperative visualization of the vessels involved with the tumor, we conducted an ICG angiography to better understand the degree of vascular involvement. During the dissection of the vessels using microsurgical techniques, the angiography was repeated multiple times until we could identify and ligate the main tumor feeder while preserving the passing vessels. 8:05 – Reconstruction: A multilayer reconstruction was performed, starting with an inlay and onlay fascia lata graft, followed by a nasal septal flap, oxidized cellulose, and fibrin glue. Finally, the nose was packed to support the reconstruction. The Institutional Review Board approval is not required. The authors certify that they have obtained all appropriate patient consent. There are no conflicts of interest. The authors confirm that there was no use of artificial intelligence (AI)-assisted technology for assisting in the writing or editing of the manuscript and no images were manipulated using AI. https://doi.org/10.25259/SNI_392_2025 The views and opinions expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Journal or its management. The information contained in this article should not be considered to be medical advice; patients should consult their own physicians for advice as to their specific medical needs.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/e43848b1-88c6-4b8d-afd5-5475d3fa12cd/featured/hero-1781558400365.png","publishDate":"2025-08-29T00:00:00.000Z","doi":"10.25259/SNI_392_2025","categories":["Skull Base","Video Abstract"],"fullTextUrl":"https://surgicalneurologyint.com/wp-content/uploads/2025/08/13909/SNI-16-373.pdf"}