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DOI: 10.1055/s-0041-1740593
Falcotentorial Meningiomas: Optimal Surgical Planning and Intraoperative Challenges - Case Report and a Review
Funding None.![](https://www.thieme-connect.de/media/10.1055-s-00028832/202204/lookinside/thumbnails/10-1055-s-0041-1740593_2000110-1.jpg)
Abstract
Meningiomas arising from the falcotentorial junction are rare, and the selection of the optimal surgical approach is essential. We report a falcotentorial meningioma (FTM) case approached by occipitotranstentorial resection and subtotal tumor resection presenting a satisfactory clinical outcome. The present review sought to reveal the current knowledge regarding the clinical presentation, radiological imaging, and the microsurgical anatomy of FTMs as a form of improving the surgical approach. The selection of the optimal surgical approach is essential for the safe and effective removal of an FTM. Preoperative imaging analysis should identify the anatomical relations of the tumor and guide toward the least disruptive route that preserves the neurovascular structures.
Keywords
falcotentorial meningioma - occipital transtentorial approach - pineal region meningioma - outcomeEthical Approval
For this type of study, formal consent is not required.
Informed Consent
The authors state that the patient his given their written informed consent for publication of data and images.
Previous Presentation
None.
Disclosure of Funding and Financial Support
None.
Contributions of the Authors
1. Bem Junior L. S.: Conceptualization, data curation, formal analysis, visualization, writing, reviewing, and editing.
2. Aquino P. L. R.: Data curation, writing of the original draft, reviewing and editing.
3. Lemos L. E. A. S.: Data curation, writing of the original draft, reviewing and editing.
4. Aquino M. A. R.: Data curation, writing, reviewing, and editing.
5. Valença M. M.: Conceptualization, writing, reviewing, and editing, supervision.
6. Azevedo Filho H. R. C.: Conceptualization, writing, reviewing, and editing, supervision.
Publication History
Received: 10 October 2020
Accepted: 30 July 2021
Article published online:
16 December 2022
© 2022. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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References
- 1 Behari S, Das KK, Kumar A. et al. Large/giant meningiomas of posterior third ventricular region: falcotentorial or velum interpositum?. Neurol India 2014; 62 (03) 290-295
- 2 Hong CK, Hong JB, Park H. et al. Surgical treatment for falcotentorial meningiomas. Yonsei Med J 2016; 57 (04) 1022-1028
- 3 Yaşar S, Kırık A. Surgical Management of Giant Intracranial Meningiomas. Eurasian J Med 2021; 53 (02) 73-78
- 4 Guttmann E. Zur pathologie und Klinik der Meningiome. Z Gesamte Neurol Psychiatr 1930; 123: 606-625
- 5 Ito J, Kadekaru T, Hayano M, Kurita I, Okada K, Yoshida Y. Meningioma in the tela choroidea of the third ventricle: CT and angiographic correlations. Neuroradiology 1981; 21 (04) 207-211
- 6 Bassiouni H, Asgari S, König HJ, Stolke D. Meningiomas of the falcotentorial junction: selection of the surgical approach according to the tumor type. Surg Neurol 2008; 69 (04) 339-349 , discussion 349
- 7 Sekhar LN, Goel A. Combined supratentorial and infratentorial approach to large pineal-region meningioma. Surg Neurol 1992; 37 (03) 197-201
- 8 Asari S, Maeshiro T, Tomita S. et al. Meningiomas arising from the falcotentorial junction. Clinical features, neuroimaging studies, and surgical treatment. J Neurosurg 1995; 82 (05) 726-738
- 9 Tubbs RS, Louis Jr RG, Wartmann CT. et al. The velum interpositum revisited and redefined. Surg Radiol Anat 2008; 30 (02) 131-135
- 10 Quinones-Hinojosa A, Chang EF, McDermott MW. Falcotentorial meningiomas: clinical, neuroimaging, and surgical features in six patients. Neurosurg Focus 2003; 14 (06) e11
- 11 Roberti F, Sekhar LN, Kalavakonda C, Wright DC. Posterior fossa meningiomas: surgical experience in 161 cases. Surg Neurol 2001; 56 (01) 8-20 , discussion 20–21. Doi: 10.1016/s0090-3019(01)00479-7
- 12 Raco A, Agrillo A, Ruggeri A, Gagliardi FM, Cantore G. Surgical options in the management of falcotentorial meningiomas: report of 13 cases. Surg Neurol 2004; 61 (02) 157-164 , discussion 164. Doi: 10.1016/S0090-3019(03)00573-1
- 13 Sung DI, Harisiadis L, Chang CH. Midline pineal tumors and suprasellar germinomas: highly curable by irradiation. Radiology 1978; 128 (03) 745-751
- 14 Piatt Jr JH, Campbell GA. Pineal region meningioma: report of two cases and literature review. Neurosurgery 1983; 12 (04) 369-376
- 15 Quiñones-Hinojosa A, Chang EF, Chaichana KL, McDermott MW. Surgical considerations in the management of falcotentorial meningiomas: advantages of the bilateral occipital transtentorial/transfalcine craniotomy for large tumors. Neurosurgery 2009;64(5, Suppl 2):260–268, discussion 268. Doi: 10.1227/01.NEU.0000344642.98597.A7
- 16 Okada T, Miyahara K, Tanino S. et al. Parieto-Occipital Interhemispheric Transfalcine, Trans-Bitentorial Approach for Radical Resection of Falcotentorial Meningiomas. J Neurol Surg A Cent Eur Neurosurg 2020; 81 (04) 355-361
- 17 Hendricks BK, Spetzler RF. Right Anterior Parasagittal Craniotomy and Interhemispheric Approach for Resection of a Falcontentorial Junction Meningioma: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2019; 17 (06) E237-E238
- 18 Lopez-Gonzalez MA, Jaeger A, Kaplan B. et al. Retractorless interhemispheric transtentorial approach for large lesions in the posterior incisural space. Surg Neurol Int 2019; 10: 130
- 19 Zhao X, Belykh E, Przybylowski CJ. et al. Surgical treatment of falcotentorial meningiomas: a retrospective review of a single-institution experience. J Neurosurg 2019; (August): 1-12
- 20 Blasco García de Andoain G, Delgado-Fernández J, Penanes Cuesta JR, Gil-Simoes R, Frade-Porto N, Sánchez MP. Meningiomas Originated at the Falcotentorial Region: Analysis of Topographic and Diagnostic Features Guiding an Optimal Surgical Planning. World Neurosurg 2019; 123: e723-e733
- 21 Mendez-Rosito D. The Supra/Infra Transtentorial Transfalcine Approach for the Removal of a Falcotentorial Meningioma: 2-Dimensional Video. Oper Neurosurg (Hagerstown) 2019; 16 (06) E166-E167
- 22 Shukla D, Behari S, Jaiswal AK, Banerji D, Tyagi I, Jain VK. Tentorial meningiomas: operative nuances and perioperative management dilemmas. Acta Neurochir (Wien) 2009; 151 (09) 1037-1051
- 23 Couldwell WT. Left occipital craniotomy for resection of falcotentorial meningioma. Neurosurg Focus 2017; 43 (VideoSuppl2): V9
- 24 Gomes D, Fonseca M, Garrotes M. et al. Corpus callosum and neglect syndrome: Clinical findings after meningioma removal and anatomical review. J Neurosci Rural Pract. Medknow Publications 2017; 8 (01) 101-106
- 25 Larson JJ, Tew Jr JM, Wiot JG, de Courten-Myers GM. Association of meningiomas with dural “tails”; surgical significance. Acta Neurochir (Wien) 1992; 114 (1-2): 59-63
- 26 Liu JK, Cohen MA. Endoscopic-assisted posterior interhemispheric retrocallosal transfalcine approach for microsurgical resection of a pineal region falcotentorial meningioma: operative video and technical nuances. Neurosurg Focus 2016;40 Video(Suppl 1):2016.1, 15453
- 27 Nowak A, Dziedzic T, Czernicki T, Kunert P, Marchel A. Falcotentorial and velum interpositum meningiomas: two distinct entities of the pineal region. Neurol Neurochir Pol 2014; 48 (06) 397-402
- 28 Qiu B, Wang Y, Ou S, Guo Z, Wang Y. The unilateral occipital transtentorial approach for pineal region meningiomas: a report of 15 cases. Int J Neurosci 2014; 124 (10) 741-747
- 29 Goto T, Ohata K, Morino M. et al. Falcotentorial meningioma: surgical outcome in 14 patients. J Neurosurg 2006; 104 (01) 47-53
- 30 Talacchi A, Biroli A, Hasanbelliu A, Locatelli F. Surgical Management of Medial Tentorial Meningioma: Falcotentorial and Torcular. World Neurosurg 2018; 115: e437-e447
- 31 Okami N, Kawamata T, Hori T, Takakura K. Surgical treatment of falcotentorial meningioma. J Clin Neurosci 2001; 8 (Suppl. 01) 15-18
- 32 Carey JP, Fisher RG, Pelofsky S. Tentorial meningiomas. Surg Neurol 1975; 3 (01) 41-44
- 33 Lozier AP, Bruce JN. Meningiomas of the velum interpositum: surgical considerations. Neurosurg Focus 2003; 15 (01) E11
- 34 Poppen JL. The right occipital approach to a pinealoma. J Neurosurg 1966; 25 (06) 706-710
- 35 Jamieson KG. Excision of pineal tumors. J Neurosurg 1971; 35 (05) 550-553
- 36 Reid WS, Clark WK. Comparison of the infratentorial and transtentorial approaches to the pineal region. Neurosurgery 1978; 3 (01) 1-8
- 37 Maselli G, De Paulis D, Ricci A, Galzio RJ. Posterior cranial fossa tumors: Results and prognostic factors in a consecutive series of 14 operated patients by occipital transtentorial approach. Surg Neurol Int 2012; 3 (01) 85
- 38 Zaidi HA, Elhadi AM, Lei T, Preul MC, Little AS, Nakaji P. Minimally Invasive Endoscopic Supracerebellar-Infratentorial Surgery of the Pineal Region: Anatomical Comparison of Four Variant Approaches. World Neurosurg 2015; 84 (02) 257-266
- 39 Quest DO, Kleriga E. Microsurgical anatomy of the pineal region. Neurosurgery 1980; 6 (04) 385-390
- 40 Sonabend AM, Bowden S, Bruce JN. Microsurgical resection of pineal region tumors. J Neurooncol 2016; 130 (02) 351-366
- 41 Stein BM. The infratentorial supracerebellar approach to pineal lesions. J Neurosurg 1971; 35 (02) 197-202
- 42 Hart MG, Santarius T, Kirollos RW. How I do it–pineal surgery: supracerebellar infratentorial versus occipital transtentorial. Acta Neurochir (Wien) 2013; 155 (03) 463-467
- 43 Soffar H, Alsawy MF. Assessment of necessity of neuronavigation in localization of calvarial extra-axial lesions in the setting of limited resources. Chin Neurosurg J 2021; 7 (01) 35
- 44 Gusmão S, Oliveira MM, Arantes A, Ulhoa TH, Morato EG. Occipital bi-transtentorial/falcine approach for falcotentorial meningioma: case report. Arq Neuropsiquiatr 2006; 64 (01) 136-138
- 45 Yağmurlu K, Zaidi HA, Kalani MYS, Rhoton AL, Preul MC, Spetzler RF. Anterior interhemispheric transsplenial approach to pineal region tumors: anatomical study and illustrative case. J Neurosurg 2018; 128 (01) 182-192