Introduction
Meningiomas arising from the falco-tentorial junction are extremely rare. As a result their clinical presentation and surgical management are not well described. Most of the meningiomas are benign, extra-axial (without infiltration of surrounding brain, only compression), slow growing tumors originating from arachnoid cells. Rare forms are malignant, characterized by fast grown. The histological pattern of our case was fibroblastic type I meningioma according to WHO classification (benign one).
Clinical case
A recent clinical case of a 71-year-old woman with a tumor originating from both - cerebral falx and tentorium with compression and dislocation of right vein of Rosenthal and vein of Galen. The patient was admitted with signs of increased intracranial pressure, moderate left hemiparesis (2/5) and left sided homonymous hemianopsia.
Method
The patient was positioned in right 3⁄4 prone position with Mayfield head clamp. A U-shaped skin incision was performed: the dura mater was in a X-shaped fashion constructed on top of transverse and superior sagittal sinuses. A right supratentorial occipital paramedian craniotomy was performed. CUSA – a machine transmitting ultrasound vibrations, was used for tumor breakdown.
Results and Clinical Imaging
A subtotal resection of the tumor (Okudera-Kobayashi grade IVA) was achieved concerning the compression of the veins of Rosenthal and Galen. Improvement of the overall condition was achieved, without sensory or motor deficits. Transient left-sided homonymous hemianopsia was resolved completely. The complaints and neurological deficits at the time of admission resolved postoperatively. There were no unexpected complications.
Conclusion
Meningiomas arising from the falcotentorial junction are quite rare. We describe in details the clinical and neuroimaging features as well as surgical management of these lesions. Overall, falcotentorial meningiomas can be safely managed by supratentorial occipital paramedian approach using CUSA. In particular cases like this one subtotal resection (Okudera-Kobayashi grade IVA) is aimed having in mind patient’s age and seeking for preservation of Galenic vein system.
Author
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Anatoli Dimitrov, MDNeurosurgery Resident
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