Bilateral Caudate Head Infarct Following Olfactory Groove Meningioma Resection

Case Report

Austin J Clin Neurol 2017; 4(1): 1098.

Bilateral Caudate Head Infarct Following Olfactory Groove Meningioma Resection

Desai K*, Spiegel LL, Godfrey RR, Damani R and Bershad EM

Department of Neurology & Vascular/Neurocritical Care, Baylor College of Medicine, USA

*Corresponding author: Desai K, Department of Neurology & Vascular/Neurocritical Care, Baylor College of Medicine1, Baylor Plaza, Houston, USA

Received: December 20, 2016; Accepted: January 23, 2017; Published: January 26, 2017


Introduction: Bilateral Recurrent Artery of Heubner (RAH) infarctions have rarely been reported in the literature. Even more so for those cases that have occurred subsequent to Neurosurgical extensive resections of large invasive Olfactory Groove Meningioma. RAH, a branch of the anterio-inferior cerebral artery, supplies anterior limb of the internal capsule, anterior caudate, putamen and globus pallidus. Infarction typically results in contralateral paresis of the arm and face. Other symptoms can occur i.e. choreiform movements, abulia, attention disorder, impaired memory, apathy, decreased spontaneity, depression, dementia etc. We present a case of Bilateral RAH infarcts as a complication of a large Olfactory Groove Meningioma resection.

Method: We did an extensive chart review of our patient during postoperative Neurointensive Care unit stay, rest of the hospital stay and discharge follow up at 3 month.

Discussion: Our patients Brain MRI done as a part of routine postoperative imaging showed bilateral caudate head infarcts in the territory of RAH. Post-operative exam was significant for a left hemianopsia and right super quadrantanopia with color desaturation. Patient did not experience any new weakness or movement related problems. He did have changes in cognition (forgetfulness & Irritability) along with a subjective loss of sense of smell but these were consistent with his pre-op assessment. Olfactory Groove Meningioma’s comprise 10% of all intracranial meningiomas, are slow growing and tend to engulf and compress neighboring structures. Most common complications of Olfactory Groove Meningioma resections are post-operative cerebral edema, CSF leak, seizures, CNS infections, hydrocephalus and rarely brain ischemia.

Conclusion: Bilateral RAH infarction, although rare has been reported in literature in association with vascular anomalies and other stroke risk factors. Cerebral infarction involving the ACA territories remains a known adverse complication of large olfactory groove meningioma resections, but bilateral infarcts due to these have not been reported before.

Keywords: Bilateral; Olfactory groove meningioma

Case Presentation

A 60-year-old right-handed male truck driver with no past medical history presented to eye clinic after six months of progressively worsening vision in the right eye, headaches, decreased sense of smell and taste, increased forgetfulness and irritability. Brain Magnetic Resonance Imaging (MRI) demonstrated a large, extra-axial mass consistent with an anterior skull base meningioma extending to the sellar and suprasellar region. Pre-op, ophthalmologic exam revealed OD hand motion detection only and OS 20/100 (Figure 1 and Figure 2). Pupils were sluggishly reactive to light bilaterally, and an OD afferent pupillary defect was present. Optic disk pallor was present in OD > OS. Slit lamp exam revealed bilateral lens nuclear sclerosis and cortical spokes. Automated perimetry showed decreased sensitivity throughout the visual field, including centrally, in OD, and temporally in OS. Visual field testing was consistent with sector scotoma bilaterally. The patient underwent an extensive 16-hour microsurgical resection with a cranio-orbito-zygomatic approach to the anterior cranial fossa and had intraoperative monitoring with somatosensory and motor evoked potentials. Bilateral A1 segments were visualized during surgery. The right Recurrent Artery of Heubner was engulfed in the tumor and was carefully dissected free and untethered from its encasement. The tumor was adherent to the optic nerves, and was invading the optic canal bilaterally and severely compressed the right greater than the left optic nerve. Simpson grade 1 resection, defined as macroscopically complete tumor resection with removal of affected dura & underlying bone, was achieved [1].

Citation: Desai K, Spiegel LL, Godfrey RR, Damani R and Bershad EM. Bilateral Caudate Head Infarct Following Olfactory Groove Meningioma Resection. Austin J Clin Neurol 2017; 4(1): 1098. ISSN:2381-9154