"Grade Zero" Removal of a Falcine Meningioma: 2-Dimensional Operative Video.

Abstract

Falcine meningiomas originate from the dura of the falx and are often concealed by an overlying rim of the cerebral cortex.1 These tumors may extend superiorly to involve the sagittal sinus or spread anteriorly and posteriorly along the dura to create a wide dural base.2 As with meningiomas of the convexity dura, which are known to manifest islands of tumor several centimeters from the tumor origin,3 falcine meningiomas can demonstrate additional tumor beyond the apparent tumor origin in the falx. This may occur in the form of additional tumor nodules along the falx or through tumor spread between the 2 dural leaflets of the falx. Although Simpson grade I resection includes the excision of the dural origin of meningioma,4 additional resection of the dura several centimeters beyond the origin of the tumor, a “grade zero” resection, can further improve long-term results.5 We use these same principles in falcine meningioma, where additional resection of the falx circumferentially around the tumor origin can eliminate occult tumor satellites or falcine tumor spread. This additional resection can minimize chances for any future tumor recurrence and improve long-term results.6 In this article, we demonstrate the concept of “grade zero” resection of falcine meningioma, where additional dural resection 2 to 3 cm beyond the origin of the tumor is performed. The patient consented for surgery. Images at 2:06 and 2:30 reprinted with permission from Al-Mefty O, Operative Atlas of Meningiomas, Vol 1, ©LWW, 1998. Image at 2:48 used with permission from Barrow Neurological Institute, Phoenix, Arizona, USA. Image at 7:59 in the public domain by age. {"href":"Single Video Player","role":"media-player-id","content-type":"play-in-place","position":"float","orientation":"portrait","label":"","caption":"","object-id":[{"pub-id-type":"doi","id":""},{"pub-id-type":"other","content-type":"media-stream-id","id":"1_q4kpu42w"},{"pub-id-type":"other","content-type":"media-source","id":"Kaltura"}]}