title: Purely endoscopic removal of a parasagittal/falx meningioma.
abstract: BACKGROUND
  Endoscopic techniques are an integral part of the neurosurgical armamentarium with a growing list of indications. We describe the purely endoscopic removal of an atypical parasagittal meningioma in a patient who could not undergo standard craniotomy due to severe scalp atrophy following childhood irradiation for tinea capitis.
  
  
  METHODS
  A 68-year-old man in good general health presented with a parasagittal meningioma that recurred following subtotal removal and adjuvant fractionated stereotactic radiosurgery (FSR). The scalp above the tumor location was very diseased and precluded a regular craniotomy for tumor removal. A 4-cm craniotomy was made in the midline forehead, where the skin was normal. A rigid endoscope was advanced under neuronavigation through the interhemispheric fissure, which provided good access with limited retraction, until the tumor was encountered at a depth of 7-8 cm. Two surgeons performed the surgery using a "four-hands technique". The tumor was removed and the insertion area was resected and coagulated.
  
  
  RESULTS
  The surgery was uneventful, with no coagulation or transection of major veins. A subtotal resection was achieved, and the patient recovered with no neurological deficit.
  
  
  CONCLUSIONS
  Safe resection of parasagittal meningiomas with a purely endoscopic technique is feasible. This option needs further exploration as an alternative strategy in patients with severely atrophic scalp skin that greatly increases the risk of significant healing complications with calvarian craniotomy.
authors.affiliation: Department of Neurosurgery, Hadassah-Hebrew University Medical Center, POB 12000, Jerusalem, Israel, 91120. sergeyspektor@gmail.com.
authors.forename: Sergey
authors.initials: S
authors.lastname: Spektor
authors.affiliation: Department of Neurosurgery, Hadassah-Hebrew University Medical Center, POB 12000, Jerusalem, Israel, 91120. emilm@hadassah.org.il.
authors.forename: Emil
authors.initials: E
authors.lastname: Margolin
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery, Hadassah-Hebrew University Medical Center, Jerusalem, Israel, 91120. ron.eliashar@gmail.com.
authors.forename: Ron
authors.initials: R
authors.lastname: Eliashar
authors.affiliation: Department of Neurosurgery, Hadassah-Hebrew University Medical Center, POB 12000, Jerusalem, Israel, 91120. samuelmoscovici@hotmail.com.
authors.forename: Samuel
authors.initials: S
authors.lastname: Moscovici
mesh_terms: D000368:Aged; D004724:Endoscopy / Q000379:methods*; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000601:surgery*; D008579:Meningioma / Q000601:surgery*; D038361:Neuronavigation / Q000379:methods*
keywords: Atypical meningioma; Endoscopic neurosurgery; Irradiation in childhood; Parasagittal/falx meningioma; Radiation-induced meningioma; Tinea capitis