Endoscopic contralateral interhemispheric transfalcine keyhole approach for large falcine meningioma. World neurosurgery Sakaeyama, Y., Morisako, H., Ohata, H., Nakajo, K., Valenzuela, J. C., Fernandez-Miranda, J. C., Goto, T. 2022


OBJECTIVE: Falcine meningioma is usually approached from ipsilaterally and the technique for tumor removal has traditionally been performed under microscopy. We report a surgical procedure for large falcine meningioma by an endoscopic contralateral interhemispheric transfalcine keyhole approach.METHODS: The study period was from September 2019 to March 2021. Study participants were patients with World Health Organization grade I meningioma showing falx attachment, excluding neurofibromatosis, who underwent initial surgery at our institution. The surgical procedure begins with a small contralateral craniotomy of about 3 cm, followed by insertion of an endoscope. The tumor attachment to the falx is excised, exposing the tumor. Internal decompression is performed, and the lesion is dissected from the surrounding brain before removal through the falx.RESULTS: An endoscopic contralateral interhemispheric transfalcine keyhole approach was used to resect four cases of large falcine meningioma. Mean operation time was 265 min (range: 216-294 min), achieving Simpson grade I removal in all cases. No evidence of cerebral infarction, cerebral edema, or new neurological complaints related to impaired venous return were seen using this surgical method.CONCLUSIONS: In the case of falcine meningioma, the endoscopic keyhole contralateral technique allows detachment of the tumor from the falx and safe manipulation in a minor field of view. In addition, because the craniotomy is smaller and the operation time is shorter, this procedure offers a less-invasive approach for the patient. This technique is thus, in our opinion, quite advantageous.

View details for DOI 10.1016/j.wneu.2022.06.148

View details for PubMedID 35809843