Meningiomas of the falcotentorial junction: selection of the surgical approach according to the tumor type

Bassiouni, Hischam; Asgari, Siamak; König, H.-J.; Stolke, D.

doi:10.1016/j.surneu.2007.02.029

Cited by 43 publications

(56 citation statements)

References 42 publications

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“…Preservation of the straight sinus and Galenic venous system is always recommended. [2] In those cases, additional resection of the falx and/or incision of the tentorium may be performed with complete resection (Simpson grade 1 and 2) in almost 85% of patients. [2]…”

Section: Discussionmentioning

confidence: 99%

Is sagittal sinus resection in falcine meningiomas a factor of bad surgical outcome?

Aguiar

Aires

Mv³

et al. 2010

Surg Neurol Int

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Objective:Meningiomas arising purely from the falx below the longitudinal sinus represents a surgical challenge for the neurosurgeon. The authors discuss the new aspects of surgical details that may avoid complications and determine the prognosis.Materials and Methods:We retrospectively evaluated our surgical experience from June 2004 to January 2010. Seventy patients harboring falcine meningiomas were included and submitted for surgical resection. All historical records, office charts and images were reviewed in order to sample the most important data regarding epidemiology, clinical pictures, radiological findings and surgical results, as well as the main complications. The patients were divided into three main groups: anterior third 32 patients (Group A), middle third 15 patients (Group B), 23 patients in the posterior third of falx (Group C).Results:In Group A, total macroscopic resection was achieved in 31 out of 32 cases (96.87%). Twenty five patients had Rankin 0, five patients had Rankin 1-2, two patients had Rankin 6. In Group B (15 patients), 10 patients had gross resection and Rankin 0, four patients had Rankin 1-2 and one patient had Rankin 6. In Group C (23 patients), 20 patients were absolutely able, Rankin score 0, after six months postoperative period (83.3% had excellent results) and no mortality. Four cases had Rankin score 1 – 2 (16.6%). Ten cases (43.47%) had Simpson I resection and ten cases (43.47%) had Simpson II.Conclusion:Despite larger lesion volumes, Group A meningiomas had a better outcome due to the position they were in, the tumor and surrounding structures. The preoperative preparation and surgical planning can preserve sagittal sinus; but in some cases, this is not possible. Sagittal sinus resection, as proven by this paper, is still a factor of bad surgical outcome. In the middle and posterior third, resection of sagittal sinus is a factor of a bad outcome, due to cerebral infartion.

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Section: Discussionmentioning

confidence: 99%

Is sagittal sinus resection in falcine meningiomas a factor of bad surgical outcome?

Aguiar

Aires

Mv³

et al. 2010

Surg Neurol Int

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“…Neurosurgeons should remove the invaded sinus walls and the tumor in the sinus and then reconstruct the removed wall with artificial materials or autologous fascia, 9,10 which could raise the risk of venous thrombosis. Occasionally, preoperative angiography is misleading, 11 as shown again in this case. Guided by the angiogram, we performed radical resection of the tumor along with the posterior quarter of the SSS, SS, bilateral TS, the confluence, the infiltrated falx, and the tentorium in a one-stage surgery.…”

Section: Discussionmentioning

confidence: 57%

Surgical Treatment of Recurrent Torcular Meningiomas: Case Report and Review of the Literature

Feng

Che

et al. 2013

J Neurol Surg A Cent Eur Neurosurg

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Torcular meningiomas intimately involving major dural sinuses such as superior sagittal sinuses, transverse sinuses, and straight sinuses and the confluence are a great challenge for neurosurgeons. Simpson grade I total resection, which can bring complete cure, is the ultimate goal, but under many circumstances, it is difficult to achieve. The patency of the sinuses around these tumors is the key factor for successful tumor resection, and decides the surgical strategy. We report the experience of complete resection of a huge recurrent torcular meningioma. Related literature is reviewed.

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“…[3,8,19,23,25,5] A summary of visual outcomes after lesions resection is shown in Table 1. Together, these studies illustrate the commonality of postoperative visual deficits experienced by falcotentorial meningioma patients after various surgical approaches.…”

Section: Discussionmentioning

confidence: 99%

“…Prolonged occipital lobe retraction may be a causative factor resulting in postoperative visual deficits,[6,15,18] as pressure on the medial occipital lobe from spatula retraction can compromise the vasculature in the calcarine area. [3] A retractorless approach has been reported to help avoid bilateral cortical blindness due to occipital lobe retraction. [4] Gravity-assisted retraction was used successfully in this study using strategic patient positioning, which resulted in the positive outcomes of tumor resection and complete preservation of visual function in all patients.…”

Section: Discussionmentioning

confidence: 99%

Retractorless interhemispheric transtentorial approach for large lesions in the posterior incisural space

López-González

Jaeger

Kaplan

et al. 2019

Surgical Neurology International

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Background: Surgical resection of lesions in the posterior incisural space presents a significant surgical challenge, which may result in postoperative visual complications and other neurological deficits. We, therefore, describe a retractorless interhemispheric transtentorial approach that avoids surrounding brain structures with positive outcomes and no complications or visual damage. Case Description: We present four cases of lesions in the posterior incisural space that was treated with a retractorless interhemispheric transtentorial approach. Two patients were previously seen at another institution for a falcotentorial meningioma. We resected the meningiomas with a parietal-occipital interhemispheric transtentorial approach with no neurological deficits. A third patient presented with a large superior vermian hemangioblastoma with a steep angle of the tentorium. The fourth patient had a large upper vermian metastatic lesion with progressive enlargement, which was refractory to radiation treatments and chemotherapy, and we achieved partial resection. Postoperative visual function was completely preserved in all patients. Conclusion: A carefully executed retractorless interhemispheric approach in select cases is an effective option to reduce morbidity and prevent visual complications when removing lesions in the posterior tentorial incisure.

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Meningiomas of the falcotentorial junction: selection of the surgical approach according to the tumor type

Cited by 43 publications

References 42 publications

Is sagittal sinus resection in falcine meningiomas a factor of bad surgical outcome?

Is sagittal sinus resection in falcine meningiomas a factor of bad surgical outcome?

Surgical Treatment of Recurrent Torcular Meningiomas: Case Report and Review of the Literature

Retractorless interhemispheric transtentorial approach for large lesions in the posterior incisural space

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