Evaluation of olfactory nerve function after aneurysmal subarachnoid hemorrhage and clip occlusion

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Object

In this study, the olfactory nerve function (ONF) in patients with an aneurysmal subarachnoid hemorrhage (SAH) who underwent neurosurgical clip occlusion for intracranial aneurysm was assessed pre- and postoperatively.

Methods

In 13 patients with an aneurysmal SAH who underwent a frontobasal or frontotemporal neurosurgical procedure for clipping of a ruptured intracranial aneurysm, ONF was assessed pre- and postoperatively by using a standardized olfactory test battery (“Sniffin' Sticks”). Preoperative testing was performed within the first 72 hours after SAH. For their follow-up visit, patients were tested 3 months after surgery. Olfactory thresholds, odor discrimination, and odor identification were documented. Only cooperative patients were included, and as a result, all patients enrolled in the study were classified in Hunt and Hess Grade II.

Results

After SAH and before surgery, three patients were normosmic, seven were hyposmic, and three were anosmic according to the Sniffin' Sticks test. Thus, 10 of 13 patients with SAH already showed disturbance of ONF preoperatively. Of these 10, however, only two patients experienced reduced smell and taste sensation. At the 3-month follow-up review, 10 patients could be tested. Three normosmic patients remained normosmic. In one patient, ONF had improved from anosmic to hyposmic, whereas in another patient, ONF had worsened from hyposmic to anosmic. Thus, in eight patients, ONF remained unchanged after surgery. Three patients reported disturbed smell and/or taste sensation. One anosmic patient had experienced no smell sensation since surgery; however, he reported his taste to be normal. Another hyposmic patient experienced both reduced smell and taste sensation. One normosmic patient reported normal smelling ability but disturbed taste sensation.

Conclusions

This study provides evidence that aneurysmal SAH causes disturbance of ONF in a substantial number of cases. With the exception of one case, neurosurgical treatment did not alter a preexisting olfactory deficit. Improvement of SAH-induced olfactory dysfunction at follow-up, however, can also be documented. The subjective assessments of the patients do not correspond well with the test battery results.

Abbreviations used in this paper:ACoA = anterior communicating artery; ONF = olfactory nerve function; SAH = subarachnoid hemorrhage; TDI = threshold, discrimination, and identification.

Article Information

Address correspondence to: Joost de Vries, M.D., Ph.D., Department of Neurosurgery, Radboud University, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands. email: j.devries@nch.umcn.nl.

© AANS, except where prohibited by US copyright law.

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References

  • 1

    Brämerson AJohansson LEk LNordin SBende M: Prevalence of olfactory dysfunction: the skövde population-based study. Laryngoscope 114:7337372004

    • Search Google Scholar
    • Export Citation
  • 2

    Cain WSGoodspeed RBGent JFLeonard G: Evaluation of olfactory dysfunction in the Connecticut Chemosensory Clinical Research Center. Laryngoscope 98:83881988

    • Search Google Scholar
    • Export Citation
  • 3

    Cardali SRomano AAngileri FFConti ALa Torre Dde Divitiis O: Microsurgical anatomic features of the olfactory nerve: relevance to olfaction preservation in the pterional approach. Neurosurgery 57:1 Suppl17212005

    • Search Google Scholar
    • Export Citation
  • 4

    Ciolkowski MMichalik RCiszek B: Arteries to the proximal part of the olfactory tract. Folia Morphol (Warsz) 63:4554582004

  • 5

    Costanzo RMMiwa T: Posttraumatic olfactory loss. Adv Otorhinolaryngol 63:991072006

  • 6

    Dare OBalos LLGrand W: Olfaction preservation in anterior cranial base approaches: an anatomic study. Neurosurgery 48:114211452001

    • Search Google Scholar
    • Export Citation
  • 7

    Doty RL: The Smell Identification Test. Administration Manual Haddon Heights, NJSensonics, Inc1989

  • 8

    Eriksen KDBoge-Rasmussen TKruse-Larsen C: Anosmia following operation for cerebral aneurysms in the anterior circulation. J Neurosurg 72:8648651990

    • Search Google Scholar
    • Export Citation
  • 9

    Feiz-Erfan IHan PPSpetzler RHorn EKlopfenstein JDKim LJ: Preserving olfactory function in anterior craniofacial surgery through cribriform plate osteotomy applied in selected patients. Neurosurgery 57:1 Suppl86932005

    • Search Google Scholar
    • Export Citation
  • 10

    Fujiwara HYasui NNathal-Vera ESuzuki A: Anosmia after anterior communicating artery aneurysm surgery: comparison between the anterior interhemispheric and basal interhemispheric approaches. Neurosurgery 38:3253281996

    • Search Google Scholar
    • Export Citation
  • 11

    Holbrook EHLeopold DA: An updated review of clinical olfaction. Curr Opin Otolaryngol Head Neck Surg 14:23282006

  • 12

    Hummel TNordin S: Olfactory disorders and their consequences for quality of life. Acta Otolaryngol 125:1161212005

  • 13

    Kobal GHummel THSekinger BBarz SRoscher SWolf S: Sniffin' sticks”: screening of olfactory performance. Rhinology 34:2222261996

    • Search Google Scholar
    • Export Citation
  • 14

    Kobal GKlimek LWofensberger MGudziol HTemmel AOwen CM: Multicenter investigation of 1,036 subjects using a standardized method for the assessment of olfactory function combining tests of odor identification, odor discrimination, and olfactory thresholds. Eur Arch Otorhinolaryngol 257:2052112000

    • Search Google Scholar
    • Export Citation
  • 15

    Kusaka GIshikawa MNanda AGranger DNZang JH: Signaling pathways for early brain injury after subarachnoid hemorrhage. J Cereb Blood Flow Metab 24:9169252004

    • Search Google Scholar
    • Export Citation
  • 16

    Landis BNHummel THugentobler MGiger RLacroix JS: Ratings of overall olfactory function. Chem Senses 28:6916942003

  • 17

    Miwa TFurukawa MTsukatani TCostanzo RMDiNardo LJReiter ER: Impact of olfactory impairment on quality of life and disability. Arch Otolaryngol Head Neck Surg 127:4975032001

    • Search Google Scholar
    • Export Citation
  • 18

    Passagia JGChirossel JPFavre JJGay EReyt ERighini C: Surgical approaches to the anterior fossa, and preservation of olfaction. Adv Tech Stand Neurosurg 25:1952411999

    • Search Google Scholar
    • Export Citation
  • 19

    Philpott CMWolstenholme CRGoodenough PCClark AMurty GE: Comparison of subjective perception with objective measurement of olfaction. Otolaryngol Head Neck Surg 134:4884902006

    • Search Google Scholar
    • Export Citation
  • 20

    Sehba FABerson JB: Mechanisms of acute brain injury after sub-arachnoid hemorrhage. Neurol Res 28:3813982006

  • 21

    Sepehrnia AKnopp U: Preservation of olfactory tract in bifrontal craniotomy for various lesions of the anterior cranial fossa. Neurosurgery 44:1131171999

    • Search Google Scholar
    • Export Citation
  • 22

    Spetzler RFHerman JMBeals SJoganic EMilligan J: Preservation of olfaction in anterior craniofacial approaches. J Neurosurg 79:48521993

    • Search Google Scholar
    • Export Citation
  • 23

    Suzuki JYoshimoto TMizoi K: Preservation of the olfactory tract in bifrontal craniotomy for anterior communicating artery aneurysms, and the functional prognosis. J Neurosurg 54:3423451981

    • Search Google Scholar
    • Export Citation
  • 24

    Temmel AFQuint CSchickinger-Fischer BKlimek LStoller EHummel T: Characteristics of olfactory disorders in relation to major causes of olfactory loss. Arch Otolaryngol Head Neck Surg 128:6356412002

    • Search Google Scholar
    • Export Citation
  • 25

    Welge-Luessen ATemmel AQuint CMoll BWolf SHummel T: Olfactory function in patients with olfactory groove meningioma. J Neurol Neurosurg Psychiatry 70:2182212001

    • Search Google Scholar
    • Export Citation
  • 26

    Wolfensberger MSchnieper I: [Sniffin'Sticks: a new system for olfactory assessment in routine clinical practice.]. HNO 47:6296361999. (Ger)

    • Search Google Scholar
    • Export Citation
  • 27

    Wolfensberger MSchnieper IWelge-Lussen A: Sniffin'Sticks: a new olfactory test battery. Acta Otolaryngol 120:3033062000

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