Surgical considerations in the management of falcotentorial meningiomas: advantages of the bilateral occipital transtentorial/transfalcine craniotomy for large tumors.
OBJECTIVE
Meningiomas arising from the falcotentorial junction are relatively rare, and the description of the surgical nuances in approaching these tumors is limited. We describe our surgical management of these lesions in detail.


METHODS
From 2001 to 2005, 9 patients underwent operation for meningiomas arising from the falcotentorial junction, with some extending to and/or invading the torcula. All patients were assessed preoperatively with magnetic resonance neuroimaging and cerebral angiography. Furthermore, preoperative embolization was attempted in all cases. A supratentorial/infratentorial torcular craniotomy technique was used in all but 1 of these cases.


RESULTS
The average dimensions of the falcotentorial meningiomas were 5.1 x 4.4 x 4.2 cm. The angiograms revealed that these tumors were fed by branches of the internal carotid artery, choroidal arteries, branches of the meningohypophyseal trunk, and branches of the posterior cerebral artery. Preoperative embolization was achieved in only 2 patients. Five patients had gross total resection (Simpson grade 1), and 4 had subtotal resection (Simpson grade 4). Two of the tumors (22%) recurred during a mean follow-up period of 49 months (range, 17-88 months). The most common complication after surgery was cortical blindness, but all postoperative visual deficits had fully recovered at the last follow-up evaluation within several months.


CONCLUSIONS
An excellent outcome can be expected with detailed preoperative neuroimaging and knowledge of the nuances of the surgical technique that we describe in detail in this article.
Quiñones-Hinojosa
Alfredo
A
Department of Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland 21231, USA. aquinon2@jhmi.edu
Chang
Edward F
EF
Chaichana
Kaisorn L
KL
McDermott
Michael W
MW
D000328:Adult; D000368:Aged; D019575:Blindness, Cortical / Q000175:diagnosis / Q000517:prevention & control; D002533:Cerebral Angiography; D003392:Cranial Sinuses / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D003399:Craniotomy / Q000379:methods*; D004210:Dissection / Q000379:methods; D004388:Dura Mater / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D005260:Female; D007839:Functional Laterality / Q000502:physiology; D006801:Humans; D007431:Intraoperative Complications / Q000517:prevention & control; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008579:Meningioma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009777:Occipital Bone / Q000033:anatomy & histology / Q000098:blood supply / Q000601:surgery*; D009778:Occipital Lobe / Q000098:blood supply / Q000601:surgery; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods; D013524:Surgical Flaps / Q000592:standards; D013525:Surgical Instruments; D016896:Treatment Outcome