title: Surgical treatment of parasagittal and falcine meningiomas of the posterior third.
abstract: BACKGROUND
  To the authors' knowledge, meningiomas of the posterior third of the falx and the parasagittal sinus have never been specifically described to date and correlated visual outcome remains unclear. With this retrospective study we describe the clinical characteristics of these tumours, their surgical management, and the improvement in visual disturbances after surgery.
  
  
  METHODS
  Twenty-six consecutive patients (22 females, 4 males; mean age, 54 years) operated on for parasagittal (n = 22) and falcine (n = 4) meningioma between 1990 and 2010 were analysed retrospectively. Preoperative planning included magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) or angiography. Sinus invasion was classified as normal, stenotic or occluded from the imaging findings and according to the Sindou classification from the intraoperative notes.
  
  
  RESULTS
  Visual disturbances and headache (in 21 and 14 cases, respectively) were the most commonly referred symptoms; visual field deficit was present in 19 patients. Simpson grade I was obtained in four patients, grade II in 15, grade III in three, and grade IV in four. The main limiting factor for total removal was sinus involvement. No perioperative deaths or relevant postoperative complications occurred. The mean follow-up was 107 months. Visual field deficit improved or resolved in almost half of the patients during the follow-up period. Three (12%) patients relapsed, two were treated with Gamma Knife surgery (stable at current writing) and the third died of disease progression.
  
  
  CONCLUSIONS
  Outcome after surgery compares favourably with other parasagittal meningioma localisations and overall morbidity is negligible. Visual function is crucial for clinical outcome. Since an improvement of the deficit might still be possible, every effort should be undertaken to preserve the visual cortex.
authors.affiliation: Section of Neurosurgery, Department of Neurological, Neuropsychological, Morphological and Movement Sciences, University of Verona, Verona, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Biroli
authors.forename: Martina
authors.initials: M
authors.lastname: Chiocchetta
authors.forename: Massimo
authors.initials: M
authors.lastname: Gerosa
authors.forename: Andrea
authors.initials: A
authors.lastname: Talacchi
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004388:Dura Mater / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000473:pathology / Q000601:surgery*; D008579:Meningioma / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D011183:Postoperative Complications / Q000473:pathology; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult