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Year : 2019  |  Volume : 14  |  Issue : 4  |  Page : 1138-1143

Neurosurgical management of parasagittal and falcine meningiomas: Judicious modern optimization of the results in a 100-case study

1 Department of Neurological Surgery, Galliera Hospitals, Genova, Italy
2 Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy

Correspondence Address:
Claudia Scudieri
Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Via Olgettina, 60 20132, Milan
Dr. Fotios Kalfas
Department of Neurological Surgery, Galliera Hospitals, Via delle Cappuccine, 16128, Genova
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ajns.AJNS_245_18

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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.

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