title: Large/giant meningiomas of posterior third ventricular region: falcotentorial or velum interpositum?
abstract: Surgical excision of rare, large-to-giant posterior third ventricular (PTV) meningiomas [including velum-interpositum meningiomas (VIM; postero-superior venous complex displacement; without falco-tentorial attachment) and falco-tentorial meningiomas (FTM; falco-tentorial attachment; displacing major veins antero-inferiorly)] is extremely challenging. To study the management nuances in the excision of large-to-giant PTV meningiomas. Tertiary care referral center. Four patients with large (>3 cm; n = 2) and giant (>5 cm; n = 2) meningiomas (FTM = 2; VIM = 2, mean tumor size = 4.9 cm) underwent occipital transtentorial approach (OTT) for tumor excision. One also underwent a second-stage supracerebellar infratentorial (SCIT) approach. The side of approach was determined by lateral tumor extension and venous displacement (right = 3, left = 1). Near-total removal or subtotal excision (<10% remaining) with radiotherapy was performed in 2 patients each, respectively. At follow-up (mean: 14.75 months), clinical improvement without tumor recurrence/re-growth was achieved. Extent of excision was determined by position of great vein of Galen; tumor attachment to falco-tentorium or major veins; its consistency; its lateral and inferior extent; and, presence of a good tumor-neuraxial arachnoidal plane. OTT is the preferable approach for large-to-giant meningiomas as it provides a wider corridor and better delineation of tumor-neurovascular arachnoidal interface.
authors.affiliation: Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
authors.forename: Sanjay
authors.initials: S
authors.lastname: Behari
authors.forename: Kuntal Kanti
authors.initials: KK
authors.lastname: Das
authors.forename: Ashish
authors.initials: A
authors.lastname: Kumar
authors.forename: Anant
authors.initials: A
authors.lastname: Mehrotra
authors.forename: Arun K
authors.initials: AK
authors.lastname: Srivastava
authors.forename: Rabi N
authors.initials: RN
authors.lastname: Sahu
authors.forename: Awadhesh K
authors.initials: AK
authors.lastname: Jaiswal
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D008579:Meningioma / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods* / Q000592:standards; D020542:Third Ventricle / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome