Modified unilateral approach for mid-third giant bifalcine meningiomas: resection using an oblique surgical trajectory and falx window
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Utilizing the shortest available trajectory is the norm for excision of meningiomas. However, such an approach for the mid-third/central falcine meningiomas risks the adjoining draining veins and eloquent cortex. A larger size and bilaterality of such tumors adds to the surgical challenge. Herein, we report the surgical nuances of a modified unilateral approach in patients operated for giant bilateral symmetrical mid-third falcine meningiomas.
Five such patients were operated. The clinico-radiologic data was studied at presentation and at the follow-up. The meningiomas were subclassified into those that were located in the anterior and posterior half of the central falx, and their surgical trajectory was chosen accordingly. The tumor was excised through an oblique anterior or a posterior trajectory instead of directly working over the major draining veins and eloquent brain. The falx was incised to create a surgical window and access the tumor on the contralateral side.
Four patients had meningiomas in the anterior half and one in the posterior half of central falx. Simpson excision was grade II in four patients. One patient showed small residual tumor and underwent stereotactic radiosurgery. The overall mean follow-up of the patients was 9.2 months. All the patients had good clinical outcome.
Giant bifalcine meningiomas can be safely resected through a unilateral approach. Falx opening serves as a window to remove the tumor from the contralateral side. An oblique trajectory rather than an end-on access to these tumors minimizes the risk of venous and cortical injury.
KeywordsFalcine Falx Bifalcine Meningioma Trajectory Unilateral Interhemispheric Mid-third
Magnetic resonance imaging
Superior sagittal sinus
Compliance with ethical standards
The procedures performed were in accordance with the ethical standards of the institutional ethics committee and with the 1964 Helsinki declaration and its later amendments. For this type of study, formal consent is not required.
Conflict of interest
The authors declare that they have no conflict of interest.
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