Jl sarrazin olfaction jfim hanoi 2015

OLFACTION
JL Sarrazin, F Benoudiba, S Hibat, D Ducreux
Hôpital Américain de Paris
CHU de Bicêtre
Hanoi, nov 2015

BACKGROUND
« Regressive » sense (?)
•  Primitif sensoriel system :
search for food, search for sexual partners.
•  Decrease of volume :
receptors, olfactory bulbs, rhinencephalon
•  Quantitative decrease :
Pheromones
•  Human species evolution :
vision development/olfactory regression.
Promote community life

BACKGROUND
Chemical stimulation-based sense
•  Like taste
•  Vision, hearing, touch :
Physical stimulation-based senses
•  Olfaction : more difficult to explore, to quantify

Olfactory receptors
Nasal mucosa in contact with cribriforme plate
—  Nasal septum
—  Superior turbinate
Olfactory mucosa:
5 cm2 in human,
20 cm2 in cats
150 cm2 in dogs
Receptors
107in human
2,2 108 in dog

Olfactory mucosa
Bipolary olfactory neurons
Extension within the mucosa ( by 8 to 20 cilia)
Apical extension with clustering of 10 to 100 fibers
Bundles of myelinated axons (Schwann cells)
Go through the cribriform plate to reach olfactory bulbs
Lifetime : 2 months. Constant renewal.

Olfactory Bulbs
Length 12mm (6 -16 mm). Volume 58 mm3 before 45 yo, 46 mm3 after 45 yo
Mitral cells (neurons)
dendrite : glomerulus
axons : Olfactory tract
Perigomerular cells….,
Olfactory nerve

Maturation of olfactory bulbs
correlating with the signal intensity of the cerebral white mat-
ter were seen in all cases (Fig 1).
At a median age of 287 days (age range, 4 days–22 months)
the OBs demonstrated thinning and slight concave deforma-
tion of their superior aspect, leading to a U-shaped appearance
in 48 studies. The periphery still showed identical signal inten-
sity to the cerebral cortex, and the central area also showed
similar signal intensity compared with cerebral white matter
(Fig 2).
At a median age of 5.2 years (age range, 107 days–19.6
years), the OBs demonstrated an adult-type form that was
smaller than those of the previous stages, with a predomi-
nantly round or slightly J-shaped aspect in 39 studies. In many
with an active intake of chemosensory information as part of
the normal fetal experience that shapes the development of
subsequent chemosensory sensitivities and preferences. The
immature fetal brain is able to register amniotic odor or
cues.10
Neonates actively encode odor cues associated with
their mothers’ breast and discriminate the odor of their moth-
er’s skin or milk from those of other mothers. This ability
allows them to modify their feeding behavior according to the
Fig 1. Pattern 1 of OBs (black arrows) shows a continuous external neuronal layer and a
central area of T2-hyperintense unmyelinated white matter.
Fig 2. Pattern 2 of OBs (black arrows) shows a thinning of the superior aspect and a still
T2-hyperintense, not yet fully myelinated, central white matter area.
Fig 3. Pattern 3 of OBs (black arrows) shows a slightly J-shaped form with a more
prominent lateral neuronal layer and a now fully myelinated central white matter area.
Fig 4. Demographics and age repartition according to the MR imaging pattern of OBs.
correlating with the signal intensity of the cerebral white mat-
ter were seen in all cases (Fig 1).
At a median age of 287 days (age range, 4 days–22 months)
the OBs demonstrated thinning and slight concave deforma-
tion of their superior aspect, leading to a U-shaped appearance
in 48 studies. The periphery still showed identical signal inten-
sity to the cerebral cortex, and the central area also showed
similar signal intensity compared with cerebral white matter
(Fig 2).
At a median age of 5.2 years (age range, 107 days–19.6
years), the OBs demonstrated an adult-type form that was
smaller than those of the previous stages, with a predomi-
nantly round or slightly J-shaped aspect in 39 studies. In many
with an active intake of chemosensory information as part of
the normal fetal experience that shapes the development of
subsequent chemosensory sensitivities and preferences. The
immature fetal brain is able to register amniotic odor or
cues.10
Neonates actively encode odor cues associated with
their mothers’ breast and discriminate the odor of their moth-
er’s skin or milk from those of other mothers. This ability
allows them to modify their feeding behavior according to the
11-13
Fig 1. Pattern 1 of OBs (black arrows) shows a continuous external neuronal layer and a
central area of T2-hyperintense unmyelinated white matter.
Fig 2. Pattern 2 of OBs (black arrows) shows a thinning of the superior aspect and a still
T2-hyperintense, not yet fully myelinated, central white matter area.
Fig 4. Demographics and age repartition according to the MR imaging pattern of OBs.
ity. They penetrate into the apical region of the hemisphere,
which projects ventrally toward the olfactory placode, which
in turn will become the elongated OBs. Eventually, the exten-
sion of the ventricular cavity into the OBs will become
obliterated.
Reflecting their embryologic origin, the external layer of
the OBs, as suggested by our study, consists of a rim of neurons
originally derived from the cortex of the telencephalic vesicle.
Cytoarchitectural studies have shown that in rodents, periph-
eral neurons are, to some extent, derived from migratory neu-
rons originating from the prestriatal subventricular zone but
can also originate from progenitor cells organized around the
core of the OBs.15,16
A similar migratory pathway has only
been identified once in humans,17
but this finding is contro-
versial.18
These peripheral cells will eventually serve as a relay
Fig 6. Serial MR imaging examinations (from top to bottom: ages 2 months, 8 months, and
18 months) in the same child show all 3 maturational steps.
Fig 5. Schematic drawing with a coronal cut through the OB, demonstrating asymmetric
neuronal layering in an adult OB. a, Nasal olfactory epithelium. b, Cribriform plate. c,
Glomerular layer. d, Mitral cell layer. e, Olfactory bulb. f, Olfactory tract.
ity. They penetrate into the apical region of the hemisphere,
which projects ventrally toward the olfactory placode, which
in turn will become the elongated OBs. Eventually, the exten-
sion of the ventricular cavity into the OBs will become
obliterated.
Reflecting their embryologic origin, the external layer of
the OBs, as suggested by our study, consists of a rim of neurons
originally derived from the cortex of the telencephalic vesicle.
Cytoarchitectural studies have shown that in rodents, periph-
eral neurons are, to some extent, derived from migratory neu-
rons originating from the prestriatal subventricular zone but
can also originate from progenitor cells organized around the
15,16
Fig 5. Schematic drawing with a coronal cut through the OB, demonstrating asymmetric
neuronal layering in an adult OB. a, Nasal olfactory epithelium. b, Cribriform plate. c,
Glomerular layer. d, Mitral cell layer. e, Olfactory bulb. f, Olfactory tract.
circular distribution of the peripheral layer of the immature
OB is seen.8
In the later stages of postnatal development, we
observed that the lateral part of the OBs (which becomes
somewhat J shaped) will become more prominent than its
medial counterpart. This can be attributed to the fact that the
lateral stria as a posterior extension of the OB is the predom-
inant anatomic bundle that projects to the primary olfactory
centers of the limbic system.20
Considering the central area of the OBs, it not only consists
of bundles of axons that project to the primary olfactory area
3 is seen in all cases after completion of the second year of life.
This parallels the visual end of myelination, as seen on T2-
weighted images for the cerebral white matter. It has been
postulated that this central T2-hyperintensity could represent
fluid-filled remnants of the ventricular cavity extension into
the OBs as in other mammals,17
which has been disputed18
and is not reflected by our results.
The interpretation of our results is subject to some limita-
tions. First, although all 3 maturation steps of the OBs do
always occur, there is a large interindividual variability in the
AJNR Am J Neuroradiol 30:1149–52 ͉ Jun-Jul 2009 ͉ www.ajnr.org 1151
ORIGINAL
RESEARCH
Maturation of the Olfactory Bulbs: MR Imaging
Findings
J.F. Schneider
F. Floemer
BACKGROUND AND PURPOSE: The detection of time-related maturational changes of the olfactory bulb
(OB) on MR imaging may help early identification of patients with abnormal OB development and
anatomic-based odor-cueing anomalies.
MATERIALS AND METHODS: Two separate reviewers retrospectively analyzed coronal T2-weighted
spin-echo MR images of the frontobasal region in 121 patients. There were 22 patients who under-
went MR imaging examinations several times, accounting for a total of 156 studies. Age range was 1
day to 19.6 years. OBs were bilaterally identified in all cases and categorized according to their shape
and signal intensity.
RESULTS: Three different anatomic patterns were identified. In pattern 1 (median age, 15 days; age
range, 1–168 days), the OBs were round to oval with a continuous external T2-hypointense rim and a
prominent T2-hyperintense central area. In pattern 2 (median age, 287 days; age range, 4 days–22
months), the OBs were U shaped, with thinning and concave deformation of the superior layer. A
hyperintense central area on T2-weighted images was still visible. In pattern 3 (median age, 5.2 years;
age range, 107 days–19.6 years), the OBs were small, round, or J shaped with a more prominent lateral
part. No difference in signal intensity between the central area and the peripheral layer was identified
anymore.
CONCLUSIONS: The OBs show time-related maturational changes on MR imaging. There is a progres-
sive reorganization of the peripheral neuronal layers and signal intensity changes of the central area,
which are completed at the end of the second year, paralleling cerebral maturational changes.
Normal anatomy of the olfactory pathways and many con-
genital or acquired anomalies have been repetitively de-
scribed.1-6
Despite considerable advance in knowledge regard-
ing the complex neuronal network associated with olfactory
stimulation, information describing the normal maturation
process in the neonatal period and childhood is scarce. There
is experimental evidence that anomalies of the face are linked
to abnormal development of the olfactory placode and bulbs.7
The importance of early detection of congenital anomalies of
the development of the olfactory bulbs (OBs) is not only to
identify patients with odor-coding deficiencies, but also to
trigger thorough examination of the frontobasal area and
midline structures, which are embryologically related, and to
look for associated cerebral malformations. Because it is rec-
ognized that OBs and nerves are not real cranial nerves but
extensions of the telencephalic vesicles, we postulated that
their maturation should parallel cerebral maturation and be
detected by MR imaging. Therefore, the purpose of our study
was to identify and characterize age-dependent maturational
changes in the OBs and tracts.
Materials and Methods
Patients
Two reviewers retrospectively analyzed all routine brain MR exami-
nations done at our institution between January 2004 and January
2007. The local ethics committee approved the study. Examinations
were excluded in cases of preterm neonates, incomplete visualization
of the OBs, and evidence of brain malformation or generalized brain
pathologic conditions.
A total of 121 children were considered eligible for the study, of
which 22 children had 2 or more consecutive studies. There were a
total of 156 cranial MR imaging examinations, of which 57 were mul-
tiple follow-ups. There were 66 boys (55%) and 53 girls (44%). Age
range was 1 day to 19.6 years (median, 373 days). Written informed
consent before examination was obtained for all patients.
Image Data Analysis
Cranial MR imaging examinations were performed on a clinical 1.5T
MR imaging system (Picker 1.5T; Picker International, Cleveland,
Ohio) and included coronal T2-weighted fast spin-echo (FSE) se-
quence, which is part of our routine examination protocol. Scan pa-
rameters were TR, 8490 ms; TE, 119 ms; matrix, 256 ϫ 384; FOV, 160
mm; section thickness, 3 mm; NEX, 2; and number of sections, 31.
The OBs were identified as prominent structures located above the
cribriform plate with a posterior thinning into the olfactory tracts,
which could be followed in all cases up to their frontobasal and, some-
times, to their limbic projectional areas. Visual inspection on coronal
T2-weighted FSE images were consensually analyzed by 2 observers
(F.F. and J.F.S.), and the OBs were discriminated according to their
shape and signal intensity pattern.
Median age and demographic distribution graphs were performed
with JMP software (JMP IN, version 5.1.2; SAS, Cary, NC).
Results
Immediately after birth, at a median age of 15 days (age range,
1–168 days), the OBs had a round to oval shape in 69 studies.
At that stage, a continuous external T2-hypointense rim that
demonstrated the same signal intensity as that of the cortical
layer of cerebral hemispheres, and a central T2-hyperintensity
Received July 4, 2008; accepted after revision December 17.
From the Department of Pediatric Radiology, University Children’s Hospital UKBB, Basel,
Switzerland.
Please address correspondence to J.F. Schneider, Department of Pediatric Radiology,
University Children’s Hospital UKBB, Ro¨mergaße 8, 4058 Basel, Switzerland; e-mail:
jacques.schneider@ukbb.ch
DOI 10.3174/ajnr.A1501
PEDIATRICSORIGINALRESEARCH
ORIGINAL
RESEARCH
Maturation of the Olfactory Bulbs: MR Imaging
Findings
J.F. Schneider
F. Floemer
BACKGROUND AND PURPOSE: The detection of time-related maturational changes of the olfactory bulb
(OB) on MR imaging may help early identification of patients with abnormal OB development and
anatomic-based odor-cueing anomalies.
MATERIALS AND METHODS: Two separate reviewers retrospectively analyzed coronal T2-weighted
spin-echo MR images of the frontobasal region in 121 patients. There were 22 patients who under-
went MR imaging examinations several times, accounting for a total of 156 studies. Age range was 1
day to 19.6 years. OBs were bilaterally identified in all cases and categorized according to their shape
and signal intensity.
RESULTS: Three different anatomic patterns were identified. In pattern 1 (median age, 15 days; age
range, 1–168 days), the OBs were round to oval with a continuous external T2-hypointense rim and a
prominent T2-hyperintense central area. In pattern 2 (median age, 287 days; age range, 4 days–22
months), the OBs were U shaped, with thinning and concave deformation of the superior layer. A
hyperintense central area on T2-weighted images was still visible. In pattern 3 (median age, 5.2 years;
age range, 107 days–19.6 years), the OBs were small, round, or J shaped with a more prominent lateral
part. No difference in signal intensity between the central area and the peripheral layer was identified
anymore.
CONCLUSIONS: The OBs show time-related maturational changes on MR imaging. There is a progres-
sive reorganization of the peripheral neuronal layers and signal intensity changes of the central area,
which are completed at the end of the second year, paralleling cerebral maturational changes.
Normal anatomy of the olfactory pathways and many con-
genital or acquired anomalies have been repetitively de-
scribed.1-6
Despite considerable advance in knowledge regard-
ing the complex neuronal network associated with olfactory
stimulation, information describing the normal maturation
process in the neonatal period and childhood is scarce. There
is experimental evidence that anomalies of the face are linked
to abnormal development of the olfactory placode and bulbs.7
The importance of early detection of congenital anomalies of
the development of the olfactory bulbs (OBs) is not only to
identify patients with odor-coding deficiencies, but also to
trigger thorough examination of the frontobasal area and
midline structures, which are embryologically related, and to
were excluded in cases of preterm neonates, incomplete visualization
of the OBs, and evidence of brain malformation or generalized brain
pathologic conditions.
A total of 121 children were considered eligible for the study, of
which 22 children had 2 or more consecutive studies. There were a
total of 156 cranial MR imaging examinations, of which 57 were mul-
tiple follow-ups. There were 66 boys (55%) and 53 girls (44%). Age
range was 1 day to 19.6 years (median, 373 days). Written informed
consent before examination was obtained for all patients.
Image Data Analysis
Cranial MR imaging examinations were performed on a clinical 1.5T
MR imaging system (Picker 1.5T; Picker International, Cleveland,

Gyrus rectus
Gyrus orbitaire
Olfactory sulcus

Olfactory tracts
Anterior perforated Substance
Olfactory trigon
Olfactory Striae
Lateral
Medial
Intermediate

Central connections
Lateral Stria
Pyriforme Cortex
Entorhinal Cortex
Amygdaloid Complex
Thalamus
Medial Stria
Anterior olfactory nucleus
(fronto basal)

Qualitative Quantitative
—  Cacosmia
—  Parosmia
—  Olfactory hallucinations
—  Hyposmia
—  Anosmia
—  Hyperosmia
Abnomalities of Olfaction

Aetiologies of Olfactory
Abnormalities

EXPLORATION
Olfactometry
Threshold of detection
Discrimination test
Recognition and memory test
Identiﬁcation test

Head and Neck clinical examination
Imaging
CT scanner
MRI

Smell physiology :4 steps
MRI : 1/3 of etiologies
⇒  Airborne Transmission of scent molecules to nasal
mucosa
⇒  Nasal Mucosa transit
⇒  Tranduction within the bipolary neuron
⇒  Central Intégration
No Imaging, CT scanner +/- MRI: 2/3 of etiologies

mucosa
No Imaging, CT scanner +/- MRI: 2/3 of etiologies

Disturbance of Airborne
transmission
Chronic inflamatory disease
Edema, inflammation, remodelling
Symptoms
Anosmia
Nasal obstruction
Rhinorrhea
Common disease
Ethmoid sinus
Nasal polyposis
Diagnosis
Symptoms
Rhinoscopy
Ct scanner
Evaluation of extent
Anatomic varaitions
R

Isolated inflammatory obstruction des
of olfactory splits (3%)

Alteration of mucosa transit
Allergic and non allergic
rhinitis
Common disease
Symptoms : dysosmia
(30%)
Another symptoms:
nasal obsttruction (80%)
Posterior Rhinorhea(80%)
Facial pain (60%)
Increase of hydrophilicity of
mucosa
Decrease of molecular
concentration
Decrease of transporter
proteins
Increase of thickness of
mucosa
Ct scanner
Search of sinusitis

Alteration of transduction
Toxic causes
Acétate Chrome Soufre
Acétone Ciment Vernis
Ammoniaque Menthol Zinc
Azote Fluor
Benzène Mercure
Carbone Nickel
Chaux Paprika
Chlore Plomb
Post rhinitic Anosmia
Viral infection
Physiopathologiy :
Destruction of bipolary
neurons
Recovery : 60% of cases
Residual dysosmia after 12
months
TDM
Search of Sinusitis

70 yo female
Headaches
Anosmia
TTT corticoïdes AB
Esthesioneuroblastoma

Esthesioneuroblastoma
Rare malignant neoplasm of nasal cavities (3%) arising
from olfactory neurepithelium
Neuroectodermal origin
Peaks : the second and sixth decades
Symptoms:
Anosmia, nasal obstruction, exophthalmia, epistaxis
Imaging : local extent, orbitary and encephalic extent.
TTT : surgery, Radiotherapy

21 yo male
Chronic Nasal Obstruction
Epistaxis
Headache. Anosmia
2 Case Rep
2
Figure 1: T2 weighted MRI with gadolinium showing enhancing
mass in left lateral nasal wall and maxillary sinus.
Figure 2: CT sinus demonstrating indolent mass with stippled
calciﬁcations centered at left middle turbinate.
with a nadir serum sodium of 114 mEq/L. Her sodium
levels normalized each time with saline administration,
and so her hyponatremia was believed to be secondary to
gastroenteritis and dehydration. In July 2007, she was seen
again for malaise and recurrent emesis and was admitted
with a sodium level at 112 mEq/L. Endocrinology was con-
Figure
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2 Case Reports in Otolaryng
Hindawi Publishing Corporation
Case Reports in Otolaryngology
Volume 2012, Article ID 582180, 6 pages
doi:10.1155/2012/582180
Case Report
Low-Grade Esthesioneuroblastoma Presenting as SIADH:
A Review of Atypical Manifestations
Andrew Senchak,1 Judy Freeman,2 Douglas Ruhl,3 Jordan Senchak,4 and Christopher Klem3
1 Department of Otolaryngology, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue Bethesda,
MD 20889-5600, USA
2 Department of Pathology, Tripler Army Medical Center, Honolulu, HI 96859 5000, USA
3 Department of Otolaryngology, Tripler Army Medical Center, Tripler AMC, Honolulu, HI 96859 5000, USA
4 Grove City College, Grove City, PA 16127, USA
Correspondence should be addressed to Andrew Senchak, andrew.senchak@us.army.mil
Received 17 October 2012; Accepted 8 November 2012
Academic Editors: J. I. De Diego, M. T. Kalcioglu, K. Morshed, C.-S. Rhee, and G. Zhou
Copyright © 2012 Andrew Senchak et al. This is an open access article distributed under the Creative Commons Attribution
License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly
cited.
Esthesioneuroblastoma (ENB) is a neuroendocrine tumor that typically manifests as advanced stage malignancy in the superior
nasal cavity. The hallmark symptoms include nasal obstruction and epistaxis, which result from local tissue invasion. Atypical
clinical features can also arise and must be considered when diagnosing and treating ENB. These can include origin in an ectopic
location, unusual presenting symptoms, and associated paraneoplastic syndromes. The case described here reports a nasal cavity
ENB with atypical clinical features that occurred in a young female. Her tumor was low grade, appeared to arise primarily from
the middle nasal cavity, and presented as syndrome of inappropriate antidiuretic hormone (SIADH). She also became pregnant
shortly after diagnosis, which had implications on her surgical management. We review the atypical features that uncommonly
occur with ENB and the clinical considerations that arise from these unusual characteristics.
1. Introduction
Esthesioneuroblastoma is a rare nasal malignancy that
accounts for 3% of all intranasal tumors [1]. A review of
the world literature revealed up to 1000 published cases and
suggested that the true incidence may be underestimated [2].
ENBs have a bimodal age of onset in the second and sixth
decades of life and most commonly manifest as aggressive
tumors in the superior aspect of the nasal cavity in close
proximity to the cribriform plate [3]. The typical symptoms
include unilateral nasal obstruction and epistaxis which
present in later stages of disease, as early lesions are usually
slow growing and asymptomatic [4].
ENBs arise from cells of neuroectodermal origin. In the
nasal cavity, this type of tissue occurs in olfactory epithelium
which can be found in the superior nasal cavity at the area
of the cribriform plate, along the superior septum, and at the
superior turbinate [5]. The pathologic features of this tumor
are distinct and include nesting, low-grade stippled nuclei
and neuroﬁbrillary stroma with formation of pseudorosettes
[6]. Like many malignancies, ENBs primarily cause invasion
and destruction of surrounding structures, with potential for
metastasis.
We describe a patient with ENB that presented in
several atypical ways—low-grade tumor which appeared to
originate in the middle nasal cavity, presentation as syn-
drome of inappropriate antidiuretic hormone (SIADH), and
diagnosis during pregnancy. We review the unusual charac-
teristics that may uncommonly occur in ENBs and which
must be considered when evaluating patients with this
malignancy.
2. Case
A 28-year-old female presented with recurrent episodes of
emesis, malaise, and diarrhea over a 3-year time period, from
2004 to 2007. She was admitted twice for hyponatremia,
Hindawi Publishing Corporation
Case Reports in Otolaryngology
Volume 2012, Article ID 582180, 6 pages
doi:10.1155/2012/582180
Case Report
Low-Grade Esthesioneu
A Review of Atypical M
Andrew Senchak,1 Judy Free
1 Department of Otolaryngology, Walter
MD 20889-5600, USA
2 Department of Pathology, Tripler Army
3 Department of Otolaryngology, Tripler
4 Grove City College, Grove City, PA 161
Correspondence should be addressed t
Received 17 October 2012; Accepted 8
Academic Editors: J. I. De Diego, M. T.
Copyright © 2012 Andrew Senchak et
License, which permits unrestricted us
cited.
Esthesioneuroblastoma (ENB) is a neu
nasal cavity. The hallmark symptoms
clinical features can also arise and mus
location, unusual presenting symptom
ENB with atypical clinical features tha
the middle nasal cavity, and presented
shortly after diagnosis, which had imp
occur with ENB and the clinical consid
TREATMENT MODALITIES
The various treatment modalities used in the mana-
gement of ENB are surgery, chemotherapy, radiation
therapy (RT) and palliative care. Nowadays, the multi-
modal approach is recommended for improved survival
and quality of life of the patients.
Surgery
The mainstay of the treatment is surgery. The advantage
of surgery is tumor removal, immediate improvement
in compressive symptoms, proper tissue for histo-
pathological and prognostic evaluation. Intracranial
extension and close proximity to the cribriform plate
and ethmoidal roof requires a combined transfacial and
neurosurgical approach
[12]
. For T1 tumors, craniotomy
is not justified when there is clear radiological evidence
of a normal cribriform plate and upper ethmoid cells.
All other patients should be managed by combined
craniofacial approach. Dulguerov et al
[5]
showed 100%
local control with craniofacial resection as compared
to 40% loca
Similarly, Spa
showed reduc
craniofacial r
approach. A
centres repo
ENB in 2012
5-year recurr
resection al
with better a
protection of
accepted pra
surgical resec
RT
Specimens fr
even en bloc,
are difficult to
nature of th
difficult to ach
minimize the
is indicated f
A disease ca
delivered to
nodal irradia
nodal irradiat
have varied f
higher RT do
neural toxicit
in delivery of
Image guide
neural toxici
in neoadjuva
and in pallia
recurrences,
radiotherapy
Chemotherap
The role of c
settings in e
metastatic tum
chances of sy
776WJCC|www.wjgnet.com
Table 3 Tumor, node, metastasis staging system
T1 Tumour involving the nasal cavity and/or paranasal sinuses
(excluding sphenoid), sparing the most superior ethmoidal cells
T2 Tumour involving the nasal cavity and/or paranasal sinuses
(including the sphenoid) with extension to or erosion of the
cribriform plate
T3 Tumour extending into the orbit or protruding into the anterior
cranial fossa, without dural invasion
T4 Tumour involving the brain
N0 No cervical lymph-node metastasis
N1 Any form of cervical lymph-node metastasis
M0 No metastases
M1 Distant metastasis
Table 2 Modified kadish staging
Stage A: Tumour limited to the nasal fossa
Stage B: Tumour extension into the paranasal sinuses
Stage C: Tumour extension beyond the paranasal sinuses and nasal cavity
Stage D: Distant metastasis

45 yo female
Hyposmia
Nasal Obstruction
Olfactory Schwannoma

Olfactory schwannoma
—  from olfactory bundles?
—  From meningeal branches of trijeminal nerve?
—  From anterior ethmoidal nerve (branche of V1)?
LL BASE REPORTS/VOLUME 1, NUMBER 1 2011
37. Bando K, Obayashi M, Tsuneharu F. A case of subfrontal
schwannoma. No Shinkei Geka 1992;20:1189–1194
[Japanese, with English abstract]
38. Harada T, Kawauchi M, Watanabe M, Kyoshima K, Kobayashi
S. Subfrontal schwannoma—case report. Neurol Med Chir
1992;32:957–960
39
40
64 SKULL BASE REPORTS/VOLUME 1, NUMBER 1 2011
Subfrontal Schwannoma Mimicking
Neuroblastoma: Case Report
Hitoshi Yamahata, M.D.,1
Kazuho Hirahara, M.D.,1
Tetsuzou Tomosugi, M.D.,1
Masahiko Yamada, M.D.,1
Takeshi Ishii, M.D.,1
Takashi Ishigami, M.D.,1
Koichi Uetsuhara, M.D.,1
Kazunobu Sueyoshi, M.D.,2
Sumika Matsukida, M.D.,2
Kazutaka Yatsushiro, M.D.,3
and Kazunori Arita, M.D.3
ABSTRACT
Computed tomography (CT), performed in a healthy 28-year-old man after
minor head injury, detected a frontal base tumor. Neurological examination revealed left
hyposmia. On magnetic resonance imaging scans, there was a heterogeneously enhanced
tumor located in the left paramedian frontal base with extension into the left ethmoid
sinus. Angiography showed a hypervascular mass in the left anterior cranial fossa; it was
mainly fed by the left ethmoidal artery. Positron emission tomography scanning showed
moderate accumulation of 11-methylmethionine and low accumulation of 18-ﬂuorodeox-
ORIGINAL ARTICLE
The Puzzling Olfactory Groove Schwannoma:
A Systematic Review
Eberval Gadelha Figueiredo, M.D., Ph.D.,1
Yougi Soga, M.D.,2
Robson Luis Oliveira Amorim, M.D.,1
Arthur Maynart Pereira Oliveira, M.D.,1
and Manoel Jacobsen Teixeira, M.D., Ph.D.1METHODS
The authors ﬁrst performed a MEDLINE
32 SKULL BASE/VOLUME 21, NUMBER 1 2011

15 yo male
Headache, visula disorders
Rapidly evolutive anosmia
Rhabdomyosarcoma

MRI : 1/3 of etiologies
mucosa

Alteration of olfatory tracts
and cortical areas
MRI
Brain
Flair, T2*, diffusion
Skull basa:
Coronal T2w
Spin echo : 2mm
T2 HR (Ciss, Fiesta, Drive,)
Volume T2 (cube, space..)
Injection if necessary

Alteration of olfatory tracts
and cortical areas
Malformation
Traumatisms
Tumors
Degenerative or inflammatory pathologies

Congenital Dysosmia
Holoprosencéphalie
CHARGE syndrom (colobome, cardiopathie, atrésie des choanes, retard de développement, anomalies des
oreilles et génitales)
Kallmann syndrom
Hypogonadotropic Hypogonadism
GnRH deficiency micopenis,cryptochidism
Anosmia or hyposmia
Olfatory bulbs hypoplasia or aplasia
Failure Olfatory system development
Sporadic or genetic transmission

TRAUMATISM
3ème cause of dysosmia
30% of severe head injuries
5% of mild brain traumatism.
Maxillo facial trauma
Occipital trauma
Shearing of olfactory axons at level of
cribirform plate
Olfactory bulbs tearing
Inferior frontal contusion

DIAGNOSTIC NEURORADIOLOGY
Olfactory bulb volume in patients with idiopathic normal
pressure hydrocephalus
Dino Podlesek & Mario Leimert & Benno Schuster &
Johannes Gerber & Gabriele Schackert &
Matthias Kirsch & Thomas Hummel
Received: 21 March 2012 /Accepted: 28 May 2012 /Published online: 9 June 2012
# Springer-Verlag 2012
Abstract
Introduction An important pathological feature of idiopathic
normal pressure hydrocephalus (iNPH) is a dysfunction of
cerebrospinal fluid dynamics. Considering the delicate olfac-
tory structures it appears possible that the olfactory bulb (OB)
is compromised by this disease. Reports on the anatomy of the
olfactory bulb and smell function in patients with idiopathic
normal pressure hydrocephalus are absent in the literature.
The main purpose of the present study was to evaluate the
olfactory bulb (OB) volume and smell function in iNPH.
Methods The study comprised 17 patients with iNPH (seven
women and ten men, mean age066 years); they were com-
pared to a group of 24 healthy people (11 women and 13
men, mean age062 years). Comprehensive assessment of
olfactory function was conducted with the "Sniffin’ Sticks"
test kit. In an additional pilot study, in a small subgroup of
eight patients, measurements were performed before and
approximately 7 months after surgical treatment of the
Results The OB volume in patients with iNPH was signif-
icantly smaller compared to healthy controls. In our small
postoperative patient population (n08), there was no signif-
icant change of the OB volume.
Conclusion In conclusion our results suggest that iNPH
significantly affects OB volumes.
Keywords Hydrocephalus . Olfactory bulb volume .
Olfaction . Smell . Brain plasticity
Introduction
Hydrocephalus is characterized by an increased accumulation
of cerebrospinal fluid within ventricles and subarachnoid
space. The triad of gait disturbance, incontinence, and demen-
tia is known as the Hakim triad [1, 2] and represents the
cardinal symptoms of idiopathic normal pressure hydroceph-
Neuroradiology (2012) 54:1229–1233
DOI 10.1007/s00234-012-1050-8
DIAGNOSTIC NEURORADIOLOGY
Olfactory bulb volume in patients with idiopathic normal
pressure hydrocephalus
Dino Podlesek & Mario Leimert & Benno Schuster &
Johannes Gerber & Gabriele Schackert &
Matthias Kirsch & Thomas Hummel
Received: 21 March 2012 /Accepted: 28 May 2012 /Published online: 9 June 2012
# Springer-Verlag 2012
Abstract
Introduction An important pathological feature of idiopathic
normal pressure hydrocephalus (iNPH) is a dysfunction of
cerebrospinal fluid dynamics. Considering the delicate olfac-
tory structures it appears possible that the olfactory bulb (OB)
is compromised by this disease. Reports on the anatomy of the
olfactory bulb and smell function in patients with idiopathic
Results The OB volume in patients with iNPH was
icantly smaller compared to healthy controls. In ou
postoperative patient population (n08), there was no
icant change of the OB volume.
Conclusion In conclusion our results suggest tha
significantly affects OB volumes.
DOI 10.1007/s00234-012-1050-8
sting intervals between surgery Why is the OB volume decreased in iNPH? Numerous
Mean Standard
deviation
T value Degrees of
freedom
P value
Age (in years) Patients 66.4 6.4 1.72 39 0.094
Controls 62.4 7.9
OB right (in mm3
) Patients 47.9 12.7 3.11 39 0.004
Controls 59.4 10.8
OB left (in mm3
) Patients 48.5 13.7 2.59 39 0.013
Controls 59.4 13.1
Odor threshold (in dilution steps) Patients 5.3 2.8 2.24 36 0.031
Controls 7.1 2.3
Odor discrimination (number correct) Patients 8.7 2.8 3.28 36 0.002
Controls 11.9 2.9
Odor identification (number correct) Patients 9.6 3.1 5.03 36 <0.001
Controls 13.5 1.6
NPH and olfactory bulbs

Idiopathic Intracranial hypertension
and olfactory bulbs
Structural Olfactory Nerve Changes in Patients Suffering
from Idiopathic Intracranial Hypertension
Christoph Schmidt1.
, Edzard Wiener1.
, Jan Hoffmann2
, Randolf Klingebiel1
, Felix Schmidt2
,
Tobias Hofmann3
, Lutz Harms2
, Hagen Kunte2
*
1 Institute of Radiology, Charite´-Universita¨tsmedizin Berlin, Berlin, Germany, 2 Department of Neurology, Charite´-Universita¨tsmedizin Berlin, Berlin, Germany,
3 Department of Psychosomatic Medicine, Charite´-Universita¨tsmedizin Berlin, Berlin, Germany
Abstract
Background: Complications of idiopathic intracranial hypertension (IIH) are usually caused by elevated intracranial pressure
(ICP). In a similar way as in the optic nerve, elevated ICP could also compromise the olfactory nerve system. On the other
side, there is growing evidence that an extensive lymphatic network system around the olfactory nerves could be disturbed
in cerebrospinal fluid disorders like IIH. The hypothesis that patients with IIH suffer from hyposmia has been suggested in
the past. However, this has not been proven in clinical studies yet. This pilot study investigates whether structural changes
of the olfactory nerve system can be detected in patients with IIH.
Methodology/Principal Findings: Twenty-three patients with IIH and 23 matched controls were included. Olfactory bulb
volume (OBV) and sulcus olfactorius (OS) depth were calculated by magnetic resonance techniques. While mean values of
total OBV (128.7638.4 vs. 130.0632.6 mm3
, p = 0.90) and mean OS depth (8.561.2 vs. 8.661.1 mm, p = 0.91) were similar in
both groups, Pearson correlation showed that patients with a shorter medical history IIH revealed a smaller OBV (r = 0.53,
p,0.01). In untreated symptomatic patients (n = 7), the effect was greater (r = 0.76, p,0.05). Patients who suffered from IIH
for less than one year (n = 8), total OBV was significantly smaller than in matched controls (116.6624.3 vs. 149.3622.2 mm3
,
p = 0.01). IIH patients with visual disturbances (n = 21) revealed a lower OS depth than patients without (8.360.9 vs.
10.861.0 mm, p,0.01).
Conclusions/Significance: The results suggest that morphological changes of the olfactory nerve system could be present
in IIH patients at an early stage of disease.
Citation: Schmidt C, Wiener E, Hoffmann J, Klingebiel R, Schmidt F, et al. (2012) Structural Olfactory Nerve Changes in Patients Suffering from Idiopathic
Intracranial Hypertension. PLoS ONE 7(4): e35221. doi:10.1371/journal.pone.0035221
Editor: Kewei Chen, Banner Alzheimer’s Institute, United States of America
Received October 29, 2011; Accepted March 13, 2012; Published April 6, 2012
Copyright: ß 2012 Schmidt et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
increased intracranial pressure (ICP) and is affecting mainly obese
women of childbearing age. The aetiology of the disorder is not
well understood but disturbed cerebrospinal fluid (CSF) dynamics
are assumed to be an important factor. Affected patients mostly
suffer from chronic disabling headache and other symptoms of
elevated ICP like visual disturbance, tinnitus and diplopia.
Impairment of visual function is often progressive and permanent
in up to 25% of all cases [1,2,3].
Similar to the optic nerve, the olfactory nerve (ON) is covered
by a meningeal sheath enclosing the subarachnoidal space.
Elevated intracranial pressure (ICP) is a characteristic feature of
IIH and could damage the olfactory nerves (ONs) directly by
mechanical impact. There are also case reports about nasal liquor
leakage in IIH patients [4,5]. The authors argue that an increased
ICP may break the nerve sheaths around the olfactory nerves that
allow for liquor passage via the cribriform plate. In addition, there
is growing evidence that an extensive lymphatic network system
absorbing acting system is located in the submu
associated with the nasal olfactory and respiratory epit
The hypothesis that patients with IIH suffer from hy
been suggested by Kapoor [7]. Giuseffi and colleagu
that up to 25% of IIH patients complain about decr
[8]. This assumption is clinically relevant, since und
therefore untreated olfactory disorders are associated w
quality of life and problems with daily life situati
Furthermore, patients with hyposmia are at higher risk
depression [11]. However, to the best of our knowled
studies investigating the ON system in patients with II
been reported in the literature.
Decreased olfactory function is mostly associated w
olfactory bulb volume (OBV) [12,13,14,15]. Buschh
investigated a large cohort of normal volunteers a
normative values for minimal-normal OBV as 58 mm
,45 years and as 46 mm3
in people .45 years
importance of the determination of the depth of olfa
PLoS ONE | www.plosone.org 1 April 2012 | Volume 7 | Issue
Idiopathic intracranial hypertension (IIH) is characterized by
increased intracranial pressure (ICP) and is affecting mainly obese
women of childbearing age. The aetiology of the disorder is not
well understood but disturbed cerebrospinal fluid (CSF) dynamics
are assumed to be an important factor. Affected patients mostly
suffer from chronic disabling headache and other symptoms of
elevated ICP like visual disturbance, tinnitus and diplopia.
Impairment of visual function is often progressive and permanent
in up to 25% of all cases [1,2,3].
Similar to the optic nerve, the olfactory nerve (ON) is covered
by a meningeal sheath enclosing the subarachnoidal space.
Elevated intracranial pressure (ICP) is a characteristic feature of
IIH and could damage the olfactory nerves (ONs) directly by
mechanical impact. There are also case reports about nasal liquor
leakage in IIH patients [4,5]. The authors argue that an increased
ICP may break the nerve sheaths around the olfactory nerves that
allow for liquor passage via the cribriform plate. In addition, there
is growing evidence that an extensive lymphatic network system
absorbing acting system is located in the submucosal space
associated with the nasal olfactory and respiratory epithelium [6].
The hypothesis that patients with IIH suffer from hyposmia has
been suggested by Kapoor [7]. Giuseffi and colleagues reported
that up to 25% of IIH patients complain about decreased smell
[8]. This assumption is clinically relevant, since undetected and
therefore untreated olfactory disorders are associated with reduced
quality of life and problems with daily life situations [9,10].
Furthermore, patients with hyposmia are at higher risk to develop
depression [11]. However, to the best of our knowledge, clinical
studies investigating the ON system in patients with IIH have not
been reported in the literature.
Decreased olfactory function is mostly associated with reduced
olfactory bulb volume (OBV) [12,13,14,15]. Buschhu¨ter et al.
investigated a large cohort of normal volunteers and defined
normative values for minimal-normal OBV as 58 mm3
in people
,45 years and as 46 mm3
in people .45 years [15]. The
importance of the determination of the depth of olfactory sulcus
PLoS ONE | www.plosone.org 1 April 2012 | Volume 7 | Issue 4 | e35221
before enrolment in the study. All clinical investigations have been
conducted according to the principles expressed in the Declaration
of Helsinki. Seventy-one patients were potentially eligible to be
included in the study. Altogether 15 patients were excluded by the
exclusion criteria shunt surgery (n = 6), body weight over 180 kg
(n = 3), pregnancy (n = 1), and magnetic resonance imaging (MRI)
phobia (n = 4). One patient fulfilled the criteria for major
depression (diagnosed by the Becks Depression Inventory and
Hamilton Rating Scale for Depression) and was excluded.
Eighteen patients could not be reached by phone, eight patients
refused because effort of participation in the study was too high for
them, and seven subjects objected to participation without
specifying any reasons. All participants underwent clinical
examination to detect olfactory disorders with a different genesis
(e.g. post-infectious, post-traumatic, current sinunasal or upper
respiratory tract infections, tumors treated with radiation or
chemotherapy, allergies, depression) at the Special Consulting
Service for Olfactory Disorders at the ENT-Department of the
Charite´ University in Berlin, Germany. Altogether, 23 patients
could be included in the study.
Each patient with IIH was matched with a control patient for
sex, age and body mass index (BMI). Controls were selected from a
local obesity center and from the hospital staff. Subjects with
was used to calculate quantitative morphological parameters.
OBV was investigated by circumnavigating the bulb contours of
all coronal slices starting from the anterior to the posterior border
of the olfactory bulb. The slice thickness was 2 mm, therefore the
OBV could be calculated using the surface areas of each coronal
section through the olfactory bulb (surface area of each coronal
section in mm2
6count of sections 6 2 mm). The OS depth was
identified at the level of the last coronal slice through the rearmost
part of the eyeball. The depth of the OS was then calculated by
drawing a straight line tangent to the borders of the straight gyrus
and internal orbital gyrus. From this line an intergyral line to the
deepest point of the OS determined the OS depth (Figure 1). MRI
study readers were blinded to the status and clinical characteristics
of the participating subjects to prevent observer-dependent bias.
Data were presented as mean 6 standard deviation (range) or as
median (range), if they were not normally distributed. The chi-
square test and independent t-test were used to analyse differences
between IIH patients and controls. To determine age-dependent
normal OBV, data proposed by Buschhu¨ter et al. ($58 mm3
in
people ,45 years and $46 mm3
in people .45 years) were used
[15]. Relationships among clinical features of IIH patients, the
OBV, and the depth of OS were examined by using Pearson
correlation coefficient r. A difference was considered significant at
a p-value of ,0.05.
Figure 1. T2-weighted high-resolution coronal images of the olfactory bulb and sulcus olfactorius. Figure 1A and 1B show T2-weighted
fast spin echo (FSE) sequences. In Figure 1A the white arrows indicate the normal dimensioned right and left bulb olfactorius. Figure 1B demonstrates
the calculation of the olfactory sulcus (OS) depth. The distance of the deepest point of the OS was determined using a tangent line from the border of
the gyrus rectus to the internal orbital gyrus.
doi:10.1371/journal.pone.0035221.g001
PLoS ONE | www.plosone.org 2 April 2012 | Volume 7 | Issue 4 | e35221

Parkinson disease and
olfactory bulbs
NAL
RCH
Association of Olfactory Bulb Volume and
Olfactory Sulcus Depth with Olfactory Function in
Patients with Parkinson Disease
Wang
. You
F. Liu
-F. Ni
hang
Guan
BACKGROUND AND PURPOSE: Olfactory dysfunction is commonly associated with IPD. We here report
the association of OB volume and OS depth with olfactory function in patients with PD.
MATERIALS AND METHODS: Morphometric analyses by using MR imaging and the Japanese T&T
olfactometer threshold test were used to evaluate olfactory structure and function in 29 patients with
PD and 29 age- and sex-matched healthy controls.
RESULTS: The olfactory recognition thresholds were significantly higher in patients with PD than in
healthy controls (3.82 Ϯ 1.25 versus 0.45 Ϯ 0.65, P Ͻ .001). Olfactory atrophy with reductions in the
volume of the OB (37.30 Ϯ 10.23 mm3
versus 44.87 Ϯ 11.84 mm3
, P Ͻ .05) and in the depth of OS
(8.90 Ϯ 1.42 mm versus 9.67 Ϯ 1.24 mm, P Ͻ .05) was observed in patients with PD but not in
controls. Positive correlations between olfactory performance and OB volumes were observed in both
patients with PD (r ϭ Ϫ0.45, P Ͻ .0001) and in controls (r ϭ Ϫ0.42, P Ͻ .0001). In contrast, there was
no significant correlation between the depth of OS and olfactory function in either cohort.
CONCLUSIONS: The results provide evidence that early olfactory dysfunction in patients with PD may
be a primary consequence of damage to the OB. Neuroimaging of olfactory structures together with
the assessment of olfactory function may be used to identify patients with PD.
ABBREVIATIONS: DWI ϭ diffusion-weighted imaging; IPD ϭ idiopathic Parkinson disease; OB ϭ
olfactory bulb; OS ϭ olfactory sulcus; PD ϭ Parkinson disease; SEM ϭ standard error of the mean;
SNpc ϭ substantia nigra pars compacta; T&T ϭ Toyota and Takagi
are common in patients with IPD, occur-
e same frequency as resting tremor.1-3
Be-
% of patients with PD have olfactory deficits
ase severity and duration.4,5
Olfactory dys-
second most common feature of this dis-
idity and akinesia.6
The high prevalence of
on in patients with IPD suggests that IPD
olfactory disease.5,6
Recent neuropatho-
depth of OS.15-18
It has been suggested that analysis of OB
volume might be helpful in differential and early diagnosis of
PD.15,18
However, recent studies did not show significant dif-
ferences in OB volume between patients with PD and healthy
controls.15,18
These results are surprising in light of the signif-
icant decrease in dopaminergic neurons in the anterior olfac-
tory nucleus, which is part of the OB.19
Moreover, the depths
of the bilateral OS measured from the coronal view in MR
BRAINORIGIN
ORIGINAL
RESEARCH
Association of Olfactory Bul
Olfactory Sulcus Depth with
Patients with Parkinson Dis
J. Wang
H. You
J.-F. Liu
D.-F. Ni
Z.-X. Zhang
J. Guan
BACKGROUND AND PURPOSE: Olfactory dysfunction is c
the association of OB volume and OS depth with olfact
MATERIALS AND METHODS: Morphometric analyses b
olfactometer threshold test were used to evaluate olfact
PD and 29 age- and sex-matched healthy controls.
RESULTS: The olfactory recognition thresholds were si
healthy controls (3.82 Ϯ 1.25 versus 0.45 Ϯ 0.65, P Ͻ .
volume of the OB (37.30 Ϯ 10.23 mm3
versus 44.87 Ϯ
(8.90 Ϯ 1.42 mm versus 9.67 Ϯ 1.24 mm, P Ͻ .05) w
controls. Positive correlations between olfactory perform
patients with PD (r ϭ Ϫ0.45, P Ͻ .0001) and in controls
no significant correlation between the depth of OS and
CONCLUSIONS: The results provide evidence that early
be a primary consequence of damage to the OB. Neuro
the assessment of olfactory function may be used to id
ABBREVIATIONS: DWI ϭ diffusion-weighted imaging;
olfactory bulb; OS ϭ olfactory sulcus; PD ϭ Parkinson
SNpc ϭ substantia nigra pars compacta; T&T ϭ Toyot
Olfactory deficits are common in patients with IPD, occur-
ring at about the same frequency as resting tremor.1-3
Be-
tween 70% and 90% of patients with PD have olfactory deficits
independent of disease severity and duration.4,5
Olfactory dys-
function is thus the second most common feature of this dis-
order, following rigidity and akinesia.6
The high prevalence of
olfactory dysfunction in patients with IPD suggests that IPD
may actually be an olfactory disease.5,6
Recent neuropatho-
logic advances suggest that the olfactory system is among the
earliest brain regions involved in PD7
and olfactory deficits are
associated with the presence of incidental Lewy bodies in the
brains of decedents without parkinsonism or dementia during
life.8
ResultsfrompostmortemstudiesrevealedLewybodiesin
the OB9
but also in other brain regions related to olfaction,
depth of OS.15-18
volume might be h
PD.15,18
However,
ferences in OB volu
controls.15,18
These
icant decrease in d
tory nucleus, which
of the bilateral OS
imaging were not d
control groups.16
T
tural changes are a
This study, ther
OS depths and the
patients with PD a
eloquent regions of the limbic and paralimbic cortices.13
These olfactory deficits have been linked to structural and/or
functional changes at the level of the OB 9,12,14,15
and OS.16
There is evidence from numerous studies that MR imaging
can be used to reliably evaluate the volume of the OB and the
Materials and Methods
Subjects
A total of 30 patients with PD (15 men and 15 women; mean age, 61.7
years; range, 43–78 years) and 30 age- and sex-matched healthy con-
trols (15 men and 15 women; mean age, 62.6 years, range, 42–81
years) were initially included in the study. The volume of the OB in
the 19th patient with PD was more than the value of mean Ϯ 3 SD,
thus this sample and the matched control were excluded. Therefore,
there were only 29 patients with PD and 29 healthy controls included
for statistical analysis. All participants were recruited through the De-
partment of Neurology at the University of Peking Union Medical
College Hospital. Diagnoses were made according to the diagnostic
Received May 11, 2010; accepted after revision September 7.
From the Department of Otolaryngology, Peking Union Medical College Hospital, Beijing,
China.
Jian Wang and Hui You contributed equally to this work.
Please address correspondence to Dao-Feng Ni, Prof. MD, Department of Otolaryngology,
Peking Union Medical College Hospital, Beijing 100730, China; e-mail: nidf@csc.
pumch.ac.cn
DOI 10.3174/ajnr.A2350
AJNR Am J Neuroradiol 32:677–81 ͉ Apr 2011 ͉ www.ajnr.org 677
Statistical Analyses
Data were expressed as mean Ϯ SEM. The various measures were
assessed by using the Statistical Package for the Social Sciences, Ver-
sion 11.5 (SPSS, Chicago, Illinois). Differences between patients with
PD and healthy controls were analyzed by a paired-samples t test.
Relationships among olfactory function, the volume of OB, and the
37.30 Ϯ 10.23 mm3
, which was statistically different from that
of the controls (t ϭ 2.98, P Ͻ .01). The mean depth of the OS
was statistically smaller in patients with PD than in control
subjects (8.90 Ϯ 1.42 mm and 9.67 Ϯ 1.24 mm, respectively;
t ϭ 2.32, P Ͻ .05).
Correlations among Olfactory Function, OB Volume, and
OS Depth
As shown in Fig 4, the volume of the OB correlated positively
with odor recognition threshold scores as obtained by T&T
olfactometry in both patients with PD and in controls, (r ϭ
Ϫ0.448 and P Ͻ .0001 for patients with PD; r ϭ Ϫ0.420, P Ͻ
.05 for controls). In contrast, there was not a significant cor-
relation between the depth of the OS and olfactory perfor-
mance in either cohort (r ϭ Ϫ0.045, P ϭ 0.81 for patients with
PD; r ϭ Ϫ0.09, P ϭ .61 for controls).
Discussion
Although most patients with PD have olfactory defi-
cits,1,2,13,18,19,28
the pathologic mechanism is unknown. The
present study indicated that there was atrophy of the olfactory
system in the patients with PD, as shown by lower OB volume
and OS depth compared with healthy controls. Most impor-
tant, the OB volume correlated positively with olfactory dys-
function in patients with PD. This will provide insight into the
critical interplay of olfactory functional loss and structural ab-
normalities in PD.
Idiopathic PD is traditionally considered a movement dis-
order, with hallmark lesions located in the SNpc. However,
Fig 2. T&T olfactometer threshold tests in patients with PD and in healthy controls. The
means of recognition thresholds are significantly higher in patients with PD than in control
subjects. Data are expressed as means Ϯ SEM.
Fig 3. OB volume (A) and OS depth (B) in patients with PD and in healthy controls. The mean OB volumes and the mean OS depths are statistically sm
control subjects. Data are expressed as means Ϯ SEM.
44,7 cc 37,3 cc
Test for early diagnosis? for differential diagnosis?

Olfactory Meningioma
degree of brain swelling.
The classical bifrontal craniotomy does
not allow a safe exposure of large OGMs, as
demonstrated by the incidence of life-
threatening complications related to brain
retraction (1, 5, 11, 18, 21). Alternative sur-
gical routes include the pterional and
orbitolateral approaches (1, 2, 11, 15, 17, 19,
21, 23, 24), which expose the posterolateral
surface of the tumor from a lateral view,
and the fronto-basal-orbital approach (8,
21), in which the tumor is accessed from
the underneath exposing its dural attach-
ment first. Here, we report our experience
with 99 OGMs and correlate the clinical
outcome of the patients with the surgical
approach used to remove the tumor. We
also define the clinical and pathologic
predictors of prognosis in OGMs.
CLINICAL MATERIAL AND METHODS
Patient Population
Ninety-nine consecutive patients with
OGMs who had been surgically treated be-
tween 1984 and 2010 at the Institute of
Neurosurgery, Università Cattolica del Sacro
Cuore, Rome, entered this study. There
were 35 men (35.4%) and 64 women
(64.6%) who ranged in age from 17 to 82
years (median 58, mean 57 years) (Table 1
and Supplementary Table S1). The most
frequent complaint was anosmia (59.6%),
followed by visual impairment (46.5%),
headache (38.4%), and mental changes
(35.4); no complaints were present in 4
patients (4%) (Table 2). The tumor was
imaged by magnetic resonance in 85 cases
and/or by computed tomography in 57
cases. Angiography was performed in 7
cases; in 3 cases preoperative embolization
was performed. In 80 cases, the tumor was
localized to the olfactory groove by
reviewing the preoperative radiologic
images; in the remaining 19 cases,
radiographic reports and surgery notes
were used. Ethmoidal invasion was
defined as paranasal sinus extension of
enhancing tumor through the floor of the
anterior cranial fossa. Two patients had
undergone previous surgery and were
referred at our institution for recurrent
tumors (Supplementary Table S1).
The median follow-up was 89 months
(range, 2e324 months). All patients were
followed up with clinical examination and
computed tomography/magnetic resonance
studies 6 months and 1 year after surgery. In
the following 10 years, patients were re-
examined at 1- or 2-year intervals. There-
after, intervals were based on each follow-
up result. Tumor recurrence was defined
as at least a 20% increase in residual tumor
or the appearance of a new lesion with at
up neuroimaging (4). Surgical mortality
was defined as death occurring within 30
days from the date of surgery.
Size and Extension of Tumors
Overall, the mean tumor size was 5.4 cm.
Meningioma size was small (3 cm) in 15 of
99 cases (15.2%), medium (3e6 cm) in 33 of
99 (33.3%), and large (6 cm) in 51 of 99
(51.5%) of cases (Table 3 and Supplementary
Table S2). The mean tumor size was 2.4 cm
(range 1.8e3 cm), 4.4 cm (range 3.5e5.5
cm), and 6.9 cm (range 6e9 cm) in small,
medium, and large OGMs, respectively.
Small OGMs had no locoregional
extension. Ethmoidal invasion was present
in 4 of 33 cases (12.1%) of medium OGMs
and in 7 of 51 cases (13.7%) of large OGMs
(Table 3). Optic nerve involvement was
present in 12 of 33 (36.4%) and 24 of 51
(47.1%) patients of medium and large
OGMs, respectively. Vascular encasement
was evident in 2 of 33 (6.1%) and 7 of 51
(13.7%) patients of medium and large
OGMs, respectively. In one patient
suffering from type II neurofibromatosis,
the tumor extended through the middle
cranial fossa of one side to the petrous
region where it collided with a vestibular
schwannoma (14). Hyperostosis of the
anterior cranial fossa was found in 28 cases
(28.3%).
99 Patients with OGMs
Characteristic No. patients
Sex, n (%)
Male 35 (35.4)
Female 64 (64.6)
Age, years
Median 58
Range 17e82
Preoperative KPS
Median 80
Range 40e100
Follow-up, months
Median 89
Range 2e324
OGM, olfactory groove meningioma; KPS, Karnofsky
performance status.
Table 2. Presenting Symptoms and
Signs in 99 Patients with OGMs
Symptoms and Signs No. Patients (%)
Anosmia 59 (59.6)
Visual impairment 46 (46.5)
Headache 38 (38.4)
Mental changes 35 (35.4)
Seizures 19 (19.2)
Papilledema 9 (9.1)
Hemiparesis 7 (7.1)
Incontinence 7 (7.1)
Optic atrophy 6 (6.1)
Epistaxis 6 (6.1)
Foster-Kennedy 3 (3.0)
Incidental 4 (4.0)
OGMs, olfactory groove meningiomas.
Table 3. Tumor Size and Growth
Patterns of 99 OGMs
Tumor Diameter and
Extension
No. Patients
(%)
3 cm 15 (15.2)
Ethmoidal invasion 0 (0)
Optic nerve involvement 0 (0)
ACoA complex involvement 0 (0)
3-6 cm 33 (33.3)
Ethmoidal invasion 4 (12.1)
Optic nerve involvement 12 (36.4)
ACoA complex involvement 2 (6.1)
6 cm 51 (51.5)
Ethmoidal invasion 7 (13.7)
Optic nerve involvement 24 (47.1)
ACoA complex involvement 7 (13.7)
OGM, olfactory groove meningiomas; ACoA, anterior
communicating artery.

Alzheimer disease
ersonne qui ne faisait quMune erreur (score 11/12). Le déclin de la
émoire épisodique est lMune des premières manifestations de la
des patients âgés avec des troubles cogni
Pr Pierre BONFILS, Paris, 27 novembre 2009
Waldton S. Clinical observations of impaired cranial function in senile dementia. Acta Psychiatr Scand 1974, 50 : 539-547.
Foster J, Sohrabi H, Verdile G. Research criteria for the diagnosis of Alzheimer’s disease : genetic risk factors, blood biomarkers and olfactory dy
3-855.
Wilson RS, Arnold SE, Schneider JA et al. Olfactory impairment in presymptomatic Alzheimer Disease. Ann N Y Acad Sci 2009, 1170 : 730-735.
Velayudhan L, Lovestone S. Smell identification test as a treatment response marker in patients with Alzheimer Disease receiving Donapezil. J
0.
Consultez tous les articles parus dans le Journal Faxé d’ORL sur le site www .regifax.fr (reche
VASTAREL 35 mg, comprimé pelliculé à libération modifiée. Composition et
libération modifiée de dichlorhydrate de trimétazidine dosés à 35 mg. Indication
traitement prophylactique de la crise d'angine de poitrine, En ORL : traitement
et des acouphènes, En ophtalmologie : traitement d'appoint des baisses d'ac
présumés d'origine vasculaire. Propriétés : Propriétés pharmacodynamiq
CARDIOLOGIE À VISÉE ANTIANGINEUSE. La trimétazidine, en préservant le m
exposée à l'hypoxie ou à l'ischémie, empêche l'abaissement
du taux intracellulaire de l'ATP. Elle assure ainsi le
nctionnement des pompes ioniques et des flux transmembranaires Na+-K+ et maintient l'homéostasie cellulaire. Les études
ntrôlées, chez l'angoreux, ont montré que la trimétazidine : augmente la réserve coronaire (le délai d'apparition des troubles
chémiques liés à l'effort), dès le 15e j du traitement, limite les à-coups tensionnels liés à l'effort, sans entraîner de variations
gnificatives de la fréquence cardiaque, diminue significativement la fréquence des crises angineuses, entraîne une
minution significative de la consommation de trinitrine. Dans une étude réalisée sur 2 mois, chez des patients recevant 50 mg
aténolol, lMajout de 1 cp à libération modifiée de trimétazidine 35 mg entraîne, par rapport au placebo, un allongement
gnificatif du délai dMapparition dMun sous-décalage de 1 mm du segment ST à lMépreuve dMeffort 12 h après la prise. Propriétés
armacocinétiques : Sur 24 h, la concentration plasmatique se maintient à des concentrations 75 % de la Cmax pendant 11
Contre-indications : Hypersensibilité à lMun des constituants du produit. Grossesse et allaitement : Éviter de prescrire
ndant la grossesse ( allaitement déconseillé. Mises en garde et précautions particulières d'emploi : Généralement
1 comp
1 boîte

Epilepsy
27 yo male
Olfactory seizures
with cacosmia
Ganglioglioma

Smell and depression
EVALUATION OF OLFACTORY FUNCTIONAL MRI IN MAJOR
DEPRESSIVE PATIENTS BEFORE AND AFTER TREATMENT
Hibat-Allah S., Tran Dong K., Skeif H., Gressier F., Corruble E., Couillet A., Ducreux D.
Neuroradiology department, Kremlin Bicêtre Hospital, 94, France.
ABSTRACT
Introduction. Olfactory disorders have been shown in major depressive patients with
increase sensitivity to unpleasant odors. The aim of our study is to evaluate patients with
major depression after 3 months of treatment using olfactory functional MRI.
Materials and methods. 10 subjects with major depression according to DSM-V criteria
were included during 15 months. Olfactory functional MRI (using BOLD method) was
performed before and after 3 months of treatment. 3 scents were used: spearmint for pleasant
odor, sandalwood for neutral odor and wine lee for unpleasant odor. Data processing and
statistical analysis was executed using matlab software (linear regression and t student test).
We performed individual analysis for every scent for the limbic lobe and for every cluster,
and global analysis.
Results.10 patients were including during 15 months. There were 80% of women with a
medium age of 36.7 years old ± 14.9 (18-65). For the global analysis, 100% of patients show
activation for wine lee versus 80% for spearmint and sandalwood with high Zscore superior to
Pr Denis Ducreux
Figure 5. Difference of activation between spearmint (left) and wine lee (right) in major depressive (21)
Courtesy Pr Ducreux Denis www.fmritools.com/teaching-files/limec-teaching-files/isipca/
10 major depressive patients
dépréssifs majeurs
Odorants stimuli
spearmint: positive odor
sandalwood : neutral odor
Wine lee : negative odor
fMRI
before and after 3 months with
venlafaxine
Mint Wine lee

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