SURG-30. CLINICAL CONSIDERATIONS, APPROACH SELECTION, AND OUTCOMES ASSOCIATED WITH TREATMENT STRATEGIES FOR FALCOTENTORIAL MENINGIOMAS: SYSTEMATIC REVIEW AND META-ANALYSIS OF THE CURRENT EVIDENCE

Abstract

Abstract INTRODUCTION Meningiomas at the falcotentorial (FT) junction are rare, as they account for only 0.3%-1.1% of all intracranial meningiomas. Clinical management of FT meningiomas can be challenging. METHODS The authors queried three databases per PRISMA guidelines to identify all studies reporting indications for surgical resection of FT meningioma. RESULTS Thirty studies reporting 224 FT patients met pre-specified inclusion criteria. Patients diagnosed with FT meningioma demonstrated a predilection for headache on initial examination (p = 0.030).Headache was the mostly commonly reported symptom, present more often than visual disturbance (RR 2.28 [1.59, 3.26], I2=0%, P < 0.00001), ataxia or imbalance (RR 0.21 [0.08, 0.35], I2= 0%, P = 0.002), and cognitive disturbance (RR 0.34 [0.20, 0.47], I2 = 12%, P < 0.00001). An overwhelming majority of lesions (n = 97, 80.2%) were benign, WHO Grade I. The primary arterial feeders supplying the FT lesions were reported in 13 studies; most commonly, these arterial feeders included the distal branches of the ICA (n = 29), ECA (n = 25), and vertebrobasilar vasculature (n = 35). Visual deficits (n = 32, 14.3%) were the most common postoperative complication.Bassiouni classification of the tumors was reported in 10 studies, with 27 (31.8%) classified as type I, 16 (18.8%) as type II, 37 (43.5%) as type III, and five (5.9%) as type IV FT meningiomas.Simpson Grade I resection (n = 76, 43.7%) was achieved in slightly less than half of cases. Cases involving multi-stage resections appeared to confer greater risk (RR 1.42 [0.72, 2.80], I2=0%, P = 0.31) for STR (failure to achieve GTR or Simpson Grade I resection). CONCLUSION The primary objective when treating FT meningiomas is to achieve gross total resection (GTR) or Simpson Grade 1 resection. Grade 2 resection is also regarded as a good outcome for these lesions. This goal should be pursued while minimizing cerebellar retraction and protecting vital vascular structures, such as the Galenic venous system.