Yonsei Med J.  2016 Jul;57(4):1022-1028. 10.3349/ymj.2016.57.4.1022.

Surgical Treatment for Falcotentorial Meningiomas

Affiliations
  • 1Department of Neurosurgery, Brain Tumor Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
  • 2Department of Neurosurgery, Kangwon National University College of Medicine, Chuncheon, Korea. nsped@kangwon.ac.kr
  • 3Department of Neurosurgery, Bundang Jesaeng General Hospital, Seongnam, Korea.
  • 4Department of Neurosurgery, Neuro-Oncology Clinic, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

Abstract

Among intracranial meningiomas, falcotentorial meningiomas, occurring at the junction of the falx cerebri and tentorial dural folds, are extremely rare. Because of their deep location, they are surrounded by critical structures, and have been regarded as one of the most challenging lesions for surgical treatment. In this study, we describe our surgical strategy for falcotentorial meningiomas and provide a review of our experience.

Keyword

Meningiomas; venous infarction; operations; craniotomy

MeSH Terms

Adult
Aged
Dura Mater/pathology
Female
Humans
Male
Meningeal Neoplasms/pathology/*surgery
Meningioma/pathology/*surgery
Middle Aged

Figure

  • Fig. 1 (A) Preoperative T1-weighted contrast-enhanced magnetic resonance images demonstrating a huge falcotentorial meningioma compressing brain stem and deep venous system. (B) Preoperative angiography showing feeders from meningohypophyseal trunk (the artery of Bernasconi-Cassinari) and posterior meningeal artery from vertebral artery. Venous phase shows occlusion of inferior sagittal sinus and basal vein of Rosenthal. (C) Postoperative T1-weighted contrast-enhanced magnetic resonance images revealing complete tumor removal. (D) Artist's drawing showing possible access area through the relatively small bone flap. View in axial plane, sagittal plane and posterior view.

  • Fig. 2 (A) Preoperative T1-weighted contrast-enhanced magnetic resonance images demonstrating a falcotentorial meningioma abutting both transverse sinus. (B) Preoperative angiography showing right side dominant transverse sinus. (C) Postoperative CT scan showing delayed occipito-cerebellar hemorrhage. (D) Follow up T1-weighted contrast-enhanced magnetic resonance images showing complete tumor removal.

  • Fig. 3 Total 11 cases' preoperative and postoperative coronal T1-weighted contrast-enhanced magnetic resonance images showing gross total tumor removal in 10 out of 11 cases.


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