Background:
Olfactory groove meningiomas develop into enormous sizes at the time of diagnosis. This favors a wide surgical corridor to ease surgical excision. The frontobasal interhemispheric approach is a feasible variant sparing additional unwanted frontal lobe traction aiming for better functional outcome.

Aim of work:
We aim for analyzing the feasibility and safety of the approach in managing large olfactory groove meningiomas.

Patients and Methods:
Retrospective study of 15 consecutive patients with large olfactory groove meningiomas ( maximum diameter ≥ 4cm) managed between 2016-2020. We analyzed functional surgical outcome with respect to patient performance, Karnofsky Performance Status scores (KPS), and cognitive status, Mini-Mental State Examination (MMSE).

Results:
Our records show we operated on 12 females and 3 males with an age range 39-64 years (mean age:50.4). No major complications were encountered. Three patients had minor complications (20%). The mean postoperative KPS score (81.6±2.4) was significantly improved. Cognitive impairment was reported in 7 patients, with varying MMSE. Improvements seen in all 5 cases with mild impairment, however, one patient with severe impairment needed further cognitive consultation and support. As regards visual outcome, unfortunately no patients with pre-operative reported visual deficits had any improvements, with no reported worsening to preoperative vision.

Conclusion:
The interhemispheric approach could be considered a safe and quite feasible approach for managing large olfactory groove meningiomas with an accepted impact on post-operative patient performance.