A REVIEW OF MICROSURGICAL APPROACHES TO FALCINE MENINGIOMAS WITH ILLUSTRATIONS

Abstract

Background: A primary falx meningioma, arises from the falxcerebri and is completely concealed by the overlying cortex, (Cushing and Eisenhardt). They tend to grow predominantly into one cerebral hemisphere but may be bilateral. May extend to the inferior edge of the superior sagittal sinus. Categorized based on their point of origin along the falxcerebri. Anterior third, arise between the crista galli and the coronal suture; Middle third, between the coronal and lambdoidal sutures; posterior third, between the lambdoidal suture and the torcula. Yasargil classified FM into: Outer FM, arise from the main body of the falx, while Inner FM, and arise in conjunction with the inferior sagittal sinus.Case Illustrations: A 58 year old female presented at KNH with an 8 month history of headaches, right lower limb weakness, vomiting. On exam was in FGC, GCS 15 with right lower limb weakness, MRC 4/5. CT and MRI showed large left posterior falcine meningioma. Craniotomy and excision via left interhemispheric approach was done. Histopathology confirmed a meningioma. Additional illustrative cases, duly cited, show microsurgical approaches for anterior and middle third FM. Discussion: FM account for 8.5% of intracranial meningiomas. Gross total resection is the single-most important predictive factor for improved surgical outcome. Mastery of microsurgical techniques in FM resection is vital in protecting important neurovascular structures close to the tumor hence a guarantee to reduced postoperative morbidity.