J Korean Neurosurg Soc.  2015 Aug;58(2):107-111. 10.3340/jkns.2015.58.2.107.

Feasibility and Efficacy of Olfactory Protection Using Gelfoam and Fibrin Glue during Anterior Communicating Artery Aneurysm Surgery

• Cho H
• Jo KI
• Yeon JY
• Hong SC
• Kim JS

• KMID: 2191317
• DOI: http://doi.org/10.3340/jkns.2015.58.2.107

Abstract

OBJECTIVE
Patients treated with surgical clipping for anterior communicating artery (A-com) aneurysm often complain of anosmia, which can markedly impede their quality of life. We introduce a simple and useful technique to reduce postoperative olfactory dysfunction in A-com aneurysm surgery.
METHODS
We retrospectively reviewed the medical records of patients who underwent surgical clipping for unruptured aneurysm from 2011-2013 by the same senior attending physician. Since March 2012, olfactory protection using gelfoam and fibrin glue was applied in A-com aneurysm surgery. Therefore we categorized patients in two groups from this time-protected group and unprotected group.
RESULTS
Of the 63 enrolled patients, 16 patients showed postoperative olfactory dysfunction-including 8 anosmia patients (protected group : unprotected group=1 : 7) and 8 hyposmia patients (protected group : unprotected group=2 : 6). Thirty five patients who received olfactory protection during surgery showed a lower rate of anosmia (p=0.037, OR 10.516, 95% CI 1.159-95.449) and olfactory dysfunction (p=0.003, OR 8.693, 95% CI 2.138-35.356). Superior direction of the aneurysm was also associated with a risk of olfactory dysfunction (p=0.015, OR 5.535, 95% CI 1.390-22.039).
CONCLUSION
Superior direction of aneurysm appears associated with postoperative olfactory dysfunction. Olfactory protection using gelfoam and fibrin glue could be a simple, safe, and useful method to preserve olfactory function during A-com aneurysm surgery.

Keyword

Olfactory dysfunction; Pterional approach; A-com aneurysm; Aneurysm clipping; Olfactory protection

MeSH Terms

Aneurysm
Arteries
Fibrin Tissue Adhesive*
Fibrin*
Gelatin Sponge, Absorbable*
Humans
Intracranial Aneurysm*
Medical Records
Olfaction Disorders
Quality of Life
Retrospective Studies
Surgical Instruments
Fibrin
Fibrin Tissue Adhesive

Figure

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  Fig. 1 A : Olfactory nerve identification. B : Gelfoam embedment between the olfactory nerve and frontal lobe. C : Fibrin glue sealing.

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  Fig. 2 A : Olfactory nerve identification. Frontal base and olfactory nerve were divided. B : Olfactory protection with embedded gelfoam and fibrin glue application.

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