Keyhole Cisternal Navigational Resection of an Inner Falx Meningioma

Abstract

Objective: The keyhole concept in neurosurgery has remained mostly limited to transcranial endoscope-assisted microsurgery or limited-sized keyhole craniotomies. In contrast, documentation of keyhole surgery, as described by Yaşargil, regarding no traumatization to the normal neural, arterial, and venous structures has appeared relatively less in the medical literature, under the term keyhole neurosurgery. Microsurgical resection of falcine meningiomas, although not infrequent, poses technical challenges related to the tumor’s anatomic relationships with the superior sagittal sinus, inferior sagittal sinus, callosomarginal arteries, pericallosal arteries, and neural structures of the medial aspects of the hemispheres. Case Description: A 35-year-old female patient with an anterior inner falcine meningioma and frontal multiple cortical veins draining into superior sagittal sinus is presented. The tumor was totally removed using a very small gap without scarifying any cortical vein. Postoperatively, the patient did very well. Conclusions: The microneurosurgical technique of navigation through aquatic cisternal corridors for surgical access is a minimally invasive technique permitting surgical manipulations through very small gaps and preserves normal neural and vascular structures.