Abstract
Background
Utilizing the shortest available trajectory is the norm for excision of meningiomas. However, such an approach for the mid-third/central falcine meningiomas risks the adjoining draining veins and eloquent cortex. A larger size and bilaterality of such tumors adds to the surgical challenge. Herein, we report the surgical nuances of a modified unilateral approach in patients operated for giant bilateral symmetrical mid-third falcine meningiomas.
Methods
Five such patients were operated. The clinico-radiologic data was studied at presentation and at the follow-up. The meningiomas were subclassified into those that were located in the anterior and posterior half of the central falx, and their surgical trajectory was chosen accordingly. The tumor was excised through an oblique anterior or a posterior trajectory instead of directly working over the major draining veins and eloquent brain. The falx was incised to create a surgical window and access the tumor on the contralateral side.
Results
Four patients had meningiomas in the anterior half and one in the posterior half of central falx. Simpson excision was grade II in four patients. One patient showed small residual tumor and underwent stereotactic radiosurgery. The overall mean follow-up of the patients was 9.2 months. All the patients had good clinical outcome.
Conclusions
Giant bifalcine meningiomas can be safely resected through a unilateral approach. Falx opening serves as a window to remove the tumor from the contralateral side. An oblique trajectory rather than an end-on access to these tumors minimizes the risk of venous and cortical injury.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Abbreviations
- FM:
-
Falcine meningiomas
- MRI:
-
Magnetic resonance imaging
- SSS:
-
Superior sagittal sinus
References
Al-Mefty O (1998) Operative atlas of meningiomas, 1st ed. Lippincott-Raven Publishers, Philadelphia
Ausman JI (2001) Strategy and technique for removal of a falcine meningioma in a patient presenting with bilateral meningiomas. Surg Neurol 55:204–208
Barajas RF Jr, Sughrue ME, McDermott MW (2010) Large falcine meningioma fed by callosomarginal branch successfully removed following contralateral interhemispheric approach. J Neuro-Oncol 97:127–131
Biroli A, Chiocchetta M, Gerosa M, Talacchi A (2012) Surgical treatment of parasagittal and falcine meningiomas of the posterior third. Acta Neurochir 154:1987–1995
Chung SB, Kim CY, Park CK, Kim DG, Jung HW (2007) Falx meningiomas: surgical results and lessons learned from 68 cases. J Korean Neurosurg Soc 42:276–280
Das KK, Gosal JS, Sharma P, Mehrotra A, Bhaisora K, Sardhara J, Srivastava A, Jaiswal AK, Kumar R, Behari S (2017) Falcine meningiomas: analysis of the impact of radiologic tumor extensions and proposal of a modified preoperative radiologic classification scheme. World Neurosurg 104:248–258
Giombini S, Solero CL, Lasio G, Morello G (1984) Immediate and late outcome of operations for parasagittal and falx meningiomas. Report of 342 cases. Surg Neurol 21:427–435
Mukherjee S, Minhas PS (2014) Contralateral approach to resection of a parafalcine meningioma--a technical note. Br J Neurosurg 28:699–700
Murrone D, De Paulis D, di Norcia V, Di Vitantonio H, Galzio RJ (2017) Surgical management of falcine meningiomas: experience of 95 patients. J Clin Neurosci 37:25–30
Nowak A, Dziedzic T, Czernicki T, Kunert P, Marchel A (2014) Surgical treatment of parasagittal and falcine meningiomas invading the superior sagittal sinus. Neurol Neurochir Pol 48:174–180
Pires de Aguiar PH, Aires R, Maldaun MV, Tahara A, de Souza Filho AM, Zicarelli CA, Ramina R (2010) Is sagittal sinus resection in falcine meningiomas a factor of bad surgical outcome? Surg Neurol Int 1:64
Rhoton AL Jr (2002) The cerebral veins. Neurosurgery 51(4 Suppl):S159–S205
Rhoton AL Jr (2002) The cerebrum. Neurosurgery 51(4 Suppl):S1–S51
Sindou M, Auque J (2000) The intracranial venous system as a neurosurgeon’s perspective. In: Cohadon F et al (eds) Advances and technical standards in neurosurgery. Advances and technical standards in neurosurgery, vol 26. Springer, Vienna
Tatarli N, Ceylan D, Canaz H, Tokmak M, Bay HH, Şeker A, Keleş E, Kiliç T, Cavdar S (2013) Falcine venous plexus within the falx cerebri: anatomical and scanning electron microscopic findings and clinical significance. Acta Neurochir 155:2183–2189 discussion 2189
Zuo FX, Wan JH, Li XJ, Qian HP, Meng XL (2012) A proposed scheme for the classification and surgical planning of falcine meningioma treatment. J Clin Neurosci 19:1679–1683
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
The procedures performed were in accordance with the ethical standards of the institutional ethics committee and with the 1964 Helsinki declaration and its later amendments. For this type of study, formal consent is not required.
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
This article is part of the Topical Collection on Tumor - Meningioma
Rights and permissions
About this article
Cite this article
Karthigeyan, M., Rajasekhar, R., Salunke, P. et al. Modified unilateral approach for mid-third giant bifalcine meningiomas: resection using an oblique surgical trajectory and falx window. Acta Neurochir 161, 327–332 (2019). https://doi.org/10.1007/s00701-018-3770-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00701-018-3770-y