Immediate and late outcome of operations for parasagittal and falx meningiomas. Report of 342 cases

doi:10.1016/0090-3019(84)90446-4

Surgical Neurology

Volume 21, Issue 5, May 1984, Pages 427-435

https://doi.org/10.1016/0090-3019(84)90446-4 Get rights and content

Abstract

The immediate results of surgery-for the most part radical surgery-in 342 cases of parasagittal and falx meningiomas are presented. The late outcome in 317 survivors observed for at least five years and possible ways of avoiding them are discussed with special reference to recurrences and disabling sequels.

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Cited by (84)

Neuronavigation in falcine meningiomasare surgery: Initial results from a Vietnamese multi-center study
2022, Annals of Medicine and Surgery
Neuronavigation has been applied in neurocenters to help neurosurgeons plan the way to resect tumor totally and decline the neuro-injuries. This study aims to initially evaluate the result of microsurgery applying neuronavigation in treating falcine meningioma, which has not been reported comprehensively in Vietnam.
This cross-sectional study enrolled 62 patients diagnosised with falcine meningioma and treated by applying neuronavigation in operation in Neurosurgery Department of Military Hospital 103 and Viet Duc University Hospital from July 2015 to March 2017. Patients were assessed complications as well as residual lesions. Evaluate surgical results when discharging from hospital according to Ojemann MD standard.
Mean tumor volume was 67.37 ± 66.61 cm³ (range 6–370 cm³). Unilateral access site was the most common with 85.48%. Mean surgery duration was 209.84 ± 70.86 min. There were 27 out of 62 patients (43.55%) need blood transfusion in surgery. Tumor volume had an impact on blood transfusion in operation with p = 0.002. 82.26% of patients had total resection (Simpson I,II). There were 4.84% of patients having haemorrhage and 3 patients (4.84%) had wound infection after operation. Short-term outcome was evaluated according to Ojemann MD standard: good outcome was 67.74%, medium 17.74%, and poor outcome 14.52%.
The application of neuronavigation and microsurgery enables surgeons to access falcine meningiomasare exactly, lessen the surgery duration, limit blood transfusion and complications after operation.
The Dural Dark-Side Approach for falcine and tentorial meningioma: A surgical series of five patients
2022, Neurochirurgie
Falcine or tentorial meningioma can be complex to resect. When large meningiomas are located in eloquent areas, a direct ipsilateral surgical approach may cause brain injury and postoperative neurological deficits. In this series, 5 patients were surgically treated using a contralateral transfalcine or transtentorial approach to minimize brain retraction. This strategy was called the Dural Dark-Side Approach (DDSA). The aim was to analyze the quality of tumor resection and postoperative outcome.
In our department, from June 2018 to January 2020, 5 patients underwent microsurgical DDSA for resection of 4 falcine and 1 tentorial meningioma. All tumors were selected on the following two criteria: large > 40 mm diameter tumor, with surrounding functional cortex. Clinical and radiologic data were retrospectively analyzed.
Mean follow-up was 20 months. No patients required use of a rigid retractor during surgery. Gross total resection was performed in 3 patients and near-total resection in 2. All patients had favorable neurologic outcome. Postoperative MRI showed no ipsilateral or contralateral brain lesions.
This series suggested that meticulous DDSA allows excellent resection in selected large falcine or tentorial meningioma. The approach offered a safe and effective surgical corridor without injuring the surrounding healthy parenchyma.
La résection de certains méningiomes falcoriels et tentoriels reste complexe. Lorsque de volumineux méningiomes se développent, en regard d’une aire anatomique éloquente, l’approche chirurgicale directe, homolatérale, risque d’entraîner une souffrance parenchymateuse, à l’origine d’un potentiel déficit neurologique postopératoire. Dans cette série, 5 patients ont été traités par une approche transdurale transfalcorielle ou transtentorielle, de manière à minimiser la rétraction cérébrale. L’objectif était d’évaluer la qualité de la résection tumorale et le résultat neurologique postopératoire.
De juin 2018 à janvier 2020, 5 méningiomes (4 falcoriels, 1 tentoriel) ont été réséqués en utilisant une approche chirurgicale transdurale transfalcorielle ou transtentorielle. Les méningiomes sélectionnés avaient tous un grand axe supérieur à 40 mm et étaient tous recouverts par un cortex cérébral fonctionnel. Les données cliniques et radiologiques ont été analysées rétrospectivement.
Le suivi moyen était de 20 mois. Aucun écarteur autostatique n’a été utilisé durant la procédure chirurgicale. La résection tumorale était macroscopiquement complète dans 3 cas et subtotale dans 2 cas. L’évolution neurologique était favorable dans tous les cas. L’IRM postopératoire n’a pas montré aucune lésion parenchymateuse, ni homolatérale ni controlatérale.
Cette série suggère qu’une approche transdurale méticuleuse, transfalcorielle ou transtentorielle peut s’avérer pertinente pour la résection de certains méningiomes volumineux insérés sur la faux ou sur la tente. Cet abord offre un corridor chirurgical suffisant pour permettre une exérèse satisfaisante, tout en minimisant le risque de lésion du parenchyme cérébral homolatéral.
Predictors of Nonroutine Discharge Disposition Among Patients with Parasagittal/Parafalcine Meningioma
2020, World Neurosurgery
Citation Excerpt :
In some patients, complete resection of meningiomas adjacent to the middle and posterior thirds of the SSS may be precluded by the risk of damaging critical venous structures. However, spared morbidity may come at the cost of increased likelihood of tumor recurrence.9,10,13-16 Anatomically complex parasagittal/parafalcine meningiomas adjacent to important midline venous structures have been shown to increase the risk of postoperative complications after surgical resection, and therefore, considerations such as anteroposterior tumor localization along the SSS and tumor invasion of the SSS are key factors to consider when studying discharge disposition in this patient population.15
Discharge disposition is an important outcome for neurosurgeons to consider in the context of high-quality, value-based care. There has been limited research into how the unique anatomic considerations associated with parasagittal/parafalcine meningioma resection may influence discharge disposition. We investigated the effects of various predictors on discharge disposition within a cohort of patients with parasagittal/parafalcine meningioma.
A total of 154 patients treated at a single institution were analyzed (2016–2019). Bivariate analysis was conducted using the Mann-Whitney U and Fisher exact tests. Multivariate analysis was conducted using logistic regression. An optimism-corrected C-statistic was calculated using 2000 bootstrap samples to assess logistic regression model performance.
Our cohort was mostly female (67.5%) and white (72.7%), with a mean age of 57.29 years. Most patients had tumors associated with the middle third of the superior sagittal sinus (SSS) (60.4%) and had tumors that were not fully occluding the SSS (74.0%). In multivariate analysis, independent predictors of nonroutine discharge disposition included 5-factor Modified Frailty Index score (odds ratio [OR], 2.06; P = 0.0088), Simpson grade IV resection (OR, 4.22; P = 0.0062), and occurrence of any postoperative complication (OR, 2.89; P = 0.031). The optimism-corrected C-statistic of our model was 0.757.
In our single-institution experience, neither extent of SSS invasion nor location along the SSS predicted nonroutine discharge, suggesting that tumor invasion and posterior location along the SSS are not necessarily contraindications to surgery. Our results also highlight the importance of frailty and tumor size in stratifying patients at risk of nonroutine discharge disposition.
Parasagittal meningiomas
2020, Handbook of Clinical Neurology
Parasagittal meningiomas are defined as meningiomas that grow into at least one wall of the superior sagittal sinus. Long- and short-term morbidity is, in addition to cortical function, related to management of venous structures and flow. Clinical management needs to address the extent of removal in the sinus wall and to address relations to the adjacent cortex, which is highly eloquent in the Rolandic and calcarine areas.
Falcine meningiomas
2020, Handbook of Clinical Neurology
Falcine meningiomas (FMs) are defined as meningiomas arising from the falx, covered by the overlying brain parenchyma, and not involving the superior sagittal sinus (SSS). FMs together with parasagittal meningiomas represent the second most common location of intracranial meningioma. Clinical presentation depends on the dimensions and location of the FM. Surgery for FM removal deserves several considerations related to bridging veins, anterior cerebral artery branches, arterial feeders, SSS involvement, FM locations, and FM dimensions. In this chapter the principal aspects influencing surgical strategy are analyzed together with approaches and management.
Natural history of intracranial meningiomas
2020, Handbook of Clinical Neurology
We know that the extent of resection is the greatest predictor of long-term survival. However, the potential tradeoff for gross total resection in difficult locations is diminished quality of life. Benign subtotally resected or small incidentally discovered meningiomas may be followed clinically especially in the elderly. In addition, radiosurgery plays a role in the treatment of meningiomas as a primary treatment modality, or as a salvage therapy. Decisions regarding management should be made with an understanding of the natural history and rate of growth. In this chapter we review the known meningioma epidemiology as well as the growth patterns of meningiomas based upon location.

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Immediate and late outcome of operations for parasagittal and falx meningiomas. Report of 342 cases

Abstract

The recurrence of intracranial meningiomas after surgical treatment

J. Neurosurg.

Olfactory meningiomas

Acta Neurochir (Wien)

La chirurgie conservatrice et réparatrice du sinus longitudinal supérieur (S.L.S.)

Neurochirurgie.

The prediction of recurrence in meningiomas

J Neurol Neurosurg Psychiatry

Meningiomas: their classification, regional behavior, life history and surgical end results

Meningiomes intracraniens et epilepsie

Neurochirurgie

Epilepsy following radical removal of parasagittal and convexity meningiomas

Acta Psychiatry Neurol Scand

Parasagittal and falx meningiomas

Les méningiomes

Total removal of a parasagittal meningioma of the posterior third of the sagittal sinus and its repair by autogenous vein graft

J. Neurosurg

Report of 280 cases of verified parasagittal meningiomas

J Neurosurg

Operative techniques for management of lesions involving the dural venous sinuses

Surg Neurol