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. 2019 Nov 25;14(4):1138-1143.
doi: 10.4103/ajns.AJNS_245_18. eCollection 2019 Oct-Dec.

Neurosurgical Management of Parasagittal and Falcine Meningiomas: Judicious Modern Optimization of the Results in a 100-Case Study

Fotios Kalfas  1 , Claudia Scudieri  2
Affiliations

Neurosurgical Management of Parasagittal and Falcine Meningiomas: Judicious Modern Optimization of the Results in a 100-Case Study

Fotios Kalfas et al. Asian J Neurosurg. .

Abstract

Context: The management of parasagittal and falcine meningiomas centers around the relationship between the tumor and the venous anatomy of the superior sagittal sinus (SSS) and the bridging veins.

Aims: The present study aims to address neurosurgical outcomes in a cohort of patients with parasagittal and falcine meningiomas >2.0 cm in the largest diameter, in which a neurosurgical/multidisciplinary treatment was considered.

Settings and design: The clinical outcomes of patients undergoing neurosurgical management for parasagittal and falcine meningiomas at the authors' institution over a 15-year period were analyzed. Analysis was limited to those tumors (primary, residual, or recurrences) >2.0 cm in the largest diameter.

Subjects and methods: The authors identified 100 patients with parasagittal/falcine meningiomas >2.0 cm in their largest diameter, who underwent neurosurgical treatment at their institution between 1999 and 2013.

Statistical analysis used: Tumor control was assessed using Kaplan-Meier analysis, and specific attention was paid to the relationship between the tumor and the SSS and its impact on tumor control and outcome.

Results: There was no difference in rates of tumor control in patients who received subtotal resection for a WHO Grade I tumor, followed by close observation, compared with those undergoing gross-total resection, primarily because no cases were observed in which the tumor remnant in the SSS demonstrated interval growth on serial imaging studies. Of patients in this series, 13% experienced at least one neurological, medical, surgical, or radiosurgical complication, and the mortality was 0%.

Conclusions: These data provide a more judicious optimization of the expected outcome that can be obtained with treatment of these tumors, in which a combination of image guidance, advanced microsurgical techniques, and conformal radiation treatments is used.

Keywords: Falcine meningiomas; microsurgical resection; parasagittal meningiomas; radiosurgery.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Kaplan–Meier survival plot for patients with a WHO Grade I tumor who were not treated with early postoperative radiosurgery, comparing recurrence/progression-free survival for patients who underwent gross total resection versus intentional subtotal resection in which tumor was left in the superior sagittal sinus or attached to bridging cortical veins. NS – Not significant
See this image and copyright information in PMC

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