Meningiomas of the falcotentorial junction: selection of the surgical approach according to the tumor type.
BACKGROUND
We retrospectively analyzed a series of patients harboring a FT meningioma with regard to clinical presentation, surgical technique, and follow-up results.


METHODS
Clinical data in a consecutive series of 13 patients treated for a meningioma of the FT junction were retrospectively reviewed. Tumors were classified into 4 types according to their dural origin and tumor extent as depicted from preoperative MRI.


RESULTS
Main presenting symptom in 9 women and 4 men (mean age, 56 years) was headache (69%) and gait disturbance (54%). Clinical examination revealed gait ataxia in 62% of the patients. The tumor displaced the vein of Galen inferiorly in 6 patients, superiorly in 2, and medially in 5 cases. The main surgical approach to the meningioma was via an occipital interhemispheric route (10 patients). Additional resection of the falx and/or incision of the tentorium was performed in 6 cases each. A complete resection (Simpson grade 1 and 2) was achieved in 85% of patients. Permanent surgical morbidity was 23%. One tumor recurrence in an atypical meningioma was observed after the mean follow-up period of 6.2 years (range, 1-14 years) with clinical and MRI examination and had to be reoperated. Eighty-five percent of the patients regained full daily activity on follow-up.


CONCLUSIONS
The surgical approach should be tailored to the dural origin and extent of the tumor as depicted from preoperative MRI. Preservation of the straight sinus and Galenic venous system is recommended.
Bassiouni
Hischam
H
Department of Neurosurgery, University Hospital Essen, 45122 Essen, Germany. hibassiouni@yahoo.de
Asgari
Siamak
S
König
Hermann-Josef
HJ
Stolke
Dietmar
D
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D003399:Craniotomy; D005260:Female; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D008579:Meningioma / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery*; D008866:Microsurgery; D008875:Middle Aged; D009777:Occipital Bone; D011859:Radiography; D012189:Retrospective Studies; D016896:Treatment Outcome