gms | German Medical Science

Objective: Surgical treatment of falcotentorial meningiomas is challenging as they occur in deep location close to important neural structures, closely related to deep venous drainage system, and usually grow silently until they reach large size. Blood supply from the tentorial arteries will differentiate them from the meningiomas arising at the velum interpositum. Occipital transtentorial approach is most useful for falcotentorial meningiomas.

Method: Retrospective analysis was done for consecutive series of patients with falcotentorial meningiomas surgically treated by author. Clinical material driven from the institutional brain tumor registry, EMR and PACS databases, surgical image files were utilized for analysis.

Results: Analysis revealed that 15 consecutive patients were treated during a period from 2001 to 2014. Mean age of 11 women and 4 men was 52.9 years. Occipital transtentorial approach was the main route of the surgery which was modified according to the size, direction of tumor growth, tumor feeders, displacement of deep veins, and attachment of the tumor along the falx and tentorium. Transfalcine approach was added when necessary. Three-quarter prone position was used in all cases except one in prone. Gross total resection was done in 14 patients (93%). No tumor recurred during the meal follow-up duration of 6.3 years in 14 patients. There was no surgical mortality. Transient visual field defect occurred in three patients. One patient developed delayed postoperative hemorrhage.

Conclusions: Detailed surgical approach and technique for resection of a giant falcotentorial meningioma will be discussed in this presentation. To avoid surgical complications, special care was taken to drain ventricular fluid in early stage of the operation, to cut off tumor supply from feeding arteries, and to carefully dissect tumor from important normal neurovascular structures while preserving deep veins. Radical resection is the treatment of choice for such tumors.