Olfactory Groove Meningioma Presenting With Visual Decline and Gait Disturbance: A Case Report.

Olfactory groove meningiomas (OGMs) are typically indolent neoplasms arising from the anterior skull base and frequently attain a considerable size prior to detection because early symptoms are often vague and nonspecific. Common clinical features include personality or behavioral alterations, diminished or absent olfaction, and gradually worsening visual impairment, which are often incorrectly attributed to psychiatric conditions or neurodegenerative processes, leading to delays in diagnosis. We report the case of a 55-year-old female who presented with a seven-month history of progressive bilateral visual decline, unilateral headaches, anosmia, and gait instability. Computed tomography (CT) revealed a well-defined, isodense frontobasal mass. Computed tomography angiography (CTA) confirmed a hypervascular lesion compatible with OGM. The patient underwent bifrontal craniotomy with a bitemporal incision, with preservation of the temporalis fascia and drilling of the tumor base to minimize recurrence. Postoperatively, the patient showed partial visual improvement and significant recovery of orientation and gait. Histopathology confirmed a WHO Grade I meningioma. This case underscores the diagnostic value of subtle frontal signs - anosmia, disorientation, and gait disturbance - in middle-aged or older adults with cognitive or visual complaints. Timely radiological assessment enables early identification of OGMs before irreversible deficits occur. The bifrontal approach with basal bone drilling remains a safe and effective strategy for achieving gross total resection while minimizing recurrence risk.