Anterior skull base meningiomas (ASMs) such as planum sphenoidale meningioma (PSM) and olfactory groove meningioma (OGM) may be symmetric around the midline. Bifrontal frontobasal approach and its variations have long been recommended as standard approach to remove these tumors. In the present report, we describe a subfrontal Falco-olfactory approach to treat these ASMs. The subfrontal Falco-olfactory approach was used to treat nine patients with anterior skull base tumor, including six patients who were diagnosed as PSM and three patients with OGM. Subfrontal craniotomy was performed with minimal dissection of temporalis muscle. In all nine cases, ipsilateral olfactory nerve and tumor base could be visualized in the initial stage of the procedure after retraction of frontal lobe carefully. This allowed for olfactory nerve preservation and early tumors devascularization. Between falx and olfactory nerve (above olfactory nerve), we gained excellent visualization of the tumor. After removal of ipsilateral side tumor, incision of the falx, other side tumor could be exposed easily. Preservation of other side olfactory nerve was also done. All patients had no postoperative complications. Thus, subfrontal transfalcial olfactory approach could be considered as a safe and versatile surgical route for ASMs.
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