Giant Olfactory Groove Meningiomas: A Case Series Demonstrating the Surgical Management and Functional Outcomes

<b>Objective</b> Giant olfactory groove meningiomas (OGMs) present technical challenges in their management, especially when their size and location complicate the evaluation and planning process, making complete removal difficult. This study provides a comprehensive analysis of the surgical approaches and outcomes encountered in the management of giant OGMs at a single institution. <b>Materials and Methods</b> This retrospective study evaluated surgical and functional outcomes in 71 patients diagnosed with giant OGMs larger than 6 cm. Tumors were excised using microsurgical resection via the bifrontal, pterional, or combined pterional and unifrontal approaches. <b>Results</b> The study comprised 48 females (67.6%) and 23 males (32.4%), with a mean age of 54.1 years. The most common pathological type was meningothelial meningioma (45%). The bifrontal approach was the most frequently used ( <i>n</i> = 47, 66.2%) and resulted in Simpson grade I or II resection in 41 patients (87.2%). The combined pterional and unifrontal approaches were used in 16 patients (22.5%), achieving Simpson grade I or II resection in 12 (75%). The pterional approach was the least commonly used ( <i>n</i> = 8), with Simpson grade I or II resection achieved in 50% of these patients. Postoperatively, visual acuity and cognitive function improved during follow-up. Postoperative complications were frequently observed after the bifrontal approach. Three patients (4.2%) died. <b>Conclusion</b> The bifrontal approach resulted in better resection of giant OGMs than other approaches but was associated with more complications. The combined pterional and unifrontal approach was superior to the pterional approach in terms of OGM resection, with no differences in complication rates. Significant postoperative improvements in functional outcomes, including visual acuity and cognitive function, were observed.