Neurosurgical Management of Parasagittal and Falcine Meningiomas: Judicious Modern Optimization of the Results in a 100-Case Study

CONTEXT: The management of parasagittal and falcine meningiomas centers around the relationship between the tumor and the venous anatomy of the superior sagittal sinus (SSS) and the bridging veins. AIMS: The present study aims to address neurosurgical outcomes in a cohort of patients with parasagittal and falcine meningiomas >2.0 cm in the largest diameter, in which a neurosurgical/multidisciplinary treatment was considered. SETTINGS AND DESIGN: The clinical outcomes of patients undergoing neurosurgical management for parasagittal and falcine meningiomas at the authors’ institution over a 15-year period were analyzed. Analysis was limited to those tumors (primary, residual, or recurrences) >2.0 cm in the largest diameter. SUBJECTS AND METHODS: The authors identified 100 patients with parasagittal/falcine meningiomas >2.0 cm in their largest diameter, who underwent neurosurgical treatment at their institution between 1999 and 2013. STATISTICAL ANALYSIS USED: Tumor control was assessed using Kaplan–Meier analysis, and specific attention was paid to the relationship between the tumor and the SSS and its impact on tumor control and outcome. RESULTS: There was no difference in rates of tumor control in patients who received subtotal resection for a WHO Grade I tumor, followed by close observation, compared with those undergoing gross-total resection, primarily because no cases were observed in which the tumor remnant in the SSS demonstrated interval growth on serial imaging studies. Of patients in this series, 13% experienced at least one neurological, medical, surgical, or radiosurgical complication, and the mortality was 0%. CONCLUSIONS: These data provide a more judicious optimization of the expected outcome that can be obtained with treatment of these tumors, in which a combination of image guidance, advanced microsurgical techniques, and conformal radiation treatments is used.