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Spontaneous recovery of Medial Prefrontal Syndrome following Giant Olfactory Groove Meningioma resection: A case report

  • Michael Lumintang Loe ,
  • Sri Maliawan ,


Introduction: Anterior skull base meningiomas are frequently associated with changes in personality and behavior. Olfactory groove meningiomas take their origin from the cribriform plate and frontoethmoidal suture in the floor of the anterior cranial base. The cardinal clinical features usually observed are mental changes, visual deterioration, and headaches as a result of olfactory or optic nerve and frontal lobe compression. However, several authors have reported minimal changes in cognition or behavior following surgical resection, and many patients do not return to their premorbid level of function.

Case presentation: A 42-year-old male with four months history of changes in behavior, apathy, and lack of motivation. Over the course of two months, his vision progressively worsened in both eyes, and he developed a diffuse, mild headache. On examination, he was fully alert and cooperative. He only had light perception and could see faint silhouettes of people. All other neurological examinations were normal. Head Computed Tomography (CT) demonstrated a large, extra-axial mass consistent with an anterior skull base mass extending to the sellar and suprasellar region, which suggests an olfactory groove meningioma. The patient underwent a bifrontal approach craniotomy tumor resection and subsequently recovered from medial prefrontal syndrome following tumor resection. Surgical tissue pathology confirmed the diagnosis as an olfactory groove meningioma.

Discussion: The anatomical location of the olfactory groove meningioma may cause prolonged psychiatric symptoms before the onset of more overt neurological deficits. Personality changes that occur may be subtle, so patients may avoid seeking treatment for their headaches and delay ophthalmic care until their complaints become severe. Anterior skull base meningiomas often involve the ventromedial prefrontal cortex (vmPFC) that is associated with elevated levels of apathy.

Conclusion: Olfactory groove meningiomas are treatable. Reversal of cognitive impairments and changes in behavior can be expected after surgical resection.


  1. Ostrom QT, Gittleman H, Liao P, Rouse C, Chen Y, Dowling J, et al. CBTRUS statistical report: Primary brain and central nervous system tumors diagnosed in the United States in 2007-2011. Neuro Oncol. 2014;16(Suppl 4): 1 - 63. DOI: 10.1093/neuronc/nou223.
  2. Abel TJ, Manzel K, Bruss J, Belfi AM, Howard MA 3rd, Tranel D. The cognitive and behavioral effects of meningioma lesions involving the ventromedial prefrontal cortex. J Neurosurg. 2016; 124(6): 1568 - 77. DOI: 10.3171/2015.5.JNS142788.
  3. Farooq G, Rehman L, Bokhari I, Rizvi SRH. Modern microsurgical resection of olfactory groove meningiomas by classical bicoronal subfrontal approach without orbital osteotomies. Asian J Neurosurg. 2018; 13(2): 258 - 63. DOI: 10.4103/ajns.AJNS_66_16.
  4. Guduk M, Yener U, Sun HI, Hacihanefioglu M, Ozduman K, Pamir MN. Pterional and Unifrontal Approaches for the Microsurgical Resection of Olfactory Groove Meningiomas: Experience with 61 Consecutive Patients. Turk Neurosurg. 2017; 27(5): 707 - 15. DOI: 10.5137/1019-5149.JTN.17154-16.1.
  5. Ciurea AV, Iencean SM, Rizea RE, Brehar FM. Olfactory groove meningiomas: A retrospective study of 59 surgical cases. Neurosurg Rev. 2012; 35(2): 195 – 202; discussion 202. DOI: 10.1007/s10143-011-0353-2.
  6. Bitter AD, Stavrinou LC, Ntoulias G, Petridis AK, Dukagjin M, Scholz M, Hassler W. The role of the pterional approach in the surgical treatment of olfactory groove meningiomas: A 20-year experience. J Neurol Surg B Skull Base. 2013; 74(2): 97 –102. DOI: 10.1055/s-0033-1333618.
  7. Romani R, Lehecka M, Gaal E, Toninelli S, Celik O, Niemela M, et al. Lateral supraorbital approach applied to olfactory groove meningiomas: Experience with 66 consecutive patients. Neurosurgery. 2009; 65(1): 39 – 52; discussion 52-3. DOI: 10.1227/01.NEU.0000346266.69493.88.
  8. Krupp W, Klein C, Koschny R, Holland H, Seifert V, Meixensberger J. Assessment of neuropsychological parameters and quality of life to evaluate outcome in patients with surgically treated supratentorial meningiomas. Neurosurgery. 2009; 64(1): 40 –47; discussion 47. DOI: 10.1227/01.NEU.0000336330.75381.39.
  9. Telera S, Carapella CM, Caroli F, Crispo F, Cristalli G, Raus L, et al. Supraorbital keyhole approach for removal of midline anterior cranial fossa meningiomas: A series of 20 consecutive cases. Neurosurg Rev. 2012; 35(1): 67 – 83; discussion 83. DOI: 10.1007/s10143-011-0340-7.
  10. Ciurea AV, Iencean SM, Risea RE, Brehar FM. Olfactory groove meningiomas. A retrospective study of 59 surgical cases. Neurosurg Rev. Sep 30, 2011.
  11. Li MS, Portman SM, Rahal A, Mohr G, Balasingam V. The lion’s mane sign: surgical results using the bilateral fronto-orbito-nasal approach in large and giant anterior skull base meningiomas. J Neurosurg. 2014; 120(2): 315 – 320. DOI: 10.3171/2013.11.JNS13552.
  12. Rami A, Duaa A, Basel M, Faisal A, Noor uddeen AM, Amer AS. Olfactory meningioma: the godfather of cognitive impairment and behavioral changes- epidemiological features scrutinized. Int J Sci Res. 2017; 6(12): 363 – 5.
  13. Jung JJ, Warren FA, Kahanowicz R. Bilateral visual loss due to a giant olfactory meningioma. Clin Ophthalmol. 2012; 6: 339 – 42. DOI:10.2147/OPTH.S30283.
  14. Madhusoodanan S, Ting MB, Farah T, Ugur U. Psychiatric aspects of brain tumors: A review. World J Psychiatry. 2015; 5(3): 273 – 285. DOI: 10.5498/wjp.v5.i3.273.
  15. Hogeveen J, Hauner KK, Chau A, Krueger F, Grafman J. Impaired Valuation Leads to Increased Apathy Following Ventromedial Prefrontal Cortex Damage. Cerebral Cortex. 2016; ;27(2): 1401 – 1408. DOI: 10.1093/cercor/bhv317.
  16. Ardila A. There are Two Different Dysexecutive Syndromes. J Neurol Disord. 2013; 1:114. DOI: 10.4172/2329-6895.1000114.
  17. Parsons TD. The Medium Is the Message that Changes the Brain. In: Cyberpsychology and the Brain: The Interaction of Neuroscience and Affective Computing. Cambridge: Cambridge University Press; 2017:77-164.

How to Cite

Loe, M. L., & Maliawan, S. (2019). Spontaneous recovery of Medial Prefrontal Syndrome following Giant Olfactory Groove Meningioma resection: A case report. Bali Medical Journal, 8(2), 380–384.




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Michael Lumintang Loe
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Sri Maliawan
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