Violation of the sense of smell during operations for aneurysms of the anterior section of the Willis circle: a systematic review of the literature

The article presents an analysis of literature data on olfactory dysfunction in patients undergoing surgery for anterior Circle of Willis aneurysms via various microsurgical approaches. Objective:To review the scientific literature and determine the incidence of postoperative olfactory dysfunction in patients with anterior Circle of Willis aneurysms treated with different microsurgical approaches, identify the causes of postoperative anosmia, and explore possible preventive measures. Materials and Methods:A literature search was conducted in PubMed and eLibrary databases. Studies were selected based on relevance and research quality. Conclusion. The incidence of olfactory dysfunction with the pterional approach ranged from 10.8 % to 58 %. The supraorbital approach had an anosmia rate of 10.9 % to 21 %. Interhemispheric approaches resulted in postoperative anosmia in 4.4 % to 43 % of cases. To prevent postoperative anosmia, the authors recommend avoiding excessive frontal lobe retraction, prolonged or excessive pressure on the olfactory tract, and emphasize the importance of early olfactory nerve dissection during microsurgical intervention. The use of hemostatic sponges and fibrin glue, minimal-sized retractors (or replacement with an aspirator), and regular nerve irrigation during surgery have also shown positive results in preventing anosmia. Anatomical features of aneurysm location should be considered, as they may predict the risk of olfactory pathway damage. The analysis highlights the need for further studies using standardized olfactometry tests and accounting for anatomical and technical factors. There is insufficient data on olfactory dysfunction following surgery for middle cerebral artery and internal carotid artery aneurysms. Promising directions include the development of intraoperative olfactory neuromonitoring and comparative studies of surgical approaches with a focus on olfactory preservation.