Widening the Operative Corridor–Evaluating the Transcortical Approach to Giant Falcine Meningiomas

Abstract

BackgroundGiant falcine meningiomas are surgically complex as they are deep in location, concealed by normal brain parenchyma, in close proximity to various neurovascular structures, and frequently involve the falx bilaterally. Although classically accessed using a bifrontal craniotomy and interhemispheric approach, little data exists on alternative operative corridors for these challenging tumors. ObjectiveTo evaluate perioperative and long-term outcomes in patients undergoing transcortical resections of giant bilateral falcine meningiomas. MethodsFrom 2013-2022, fourteen patients with giant bilateral falcine meningiomas treated via a transcortical approach at our institution were identified. Perioperative and long-term outcomes were evaluated to determine predictors of adverse events. Corticectomy depth was also analyzed to determine if it correlated with increased postoperative seizure rates. Results57.1% of cases were WHO grade 2 meningiomas. Average tumor volume was 77.8 ± 46.5 cm3 and near/gross total resection was achieved in 78.6% of patients. No patient developed a venous infarct or had seizures in the 6 months after surgery. Average corticectomy depth was 0.83 ± 0.71 cm and increasing corticectomy depth did not correlate with higher risk of postoperative seizures (p = 0.44). Increasing extent of tumor resection correlated with lower tumor grade (p = 0.011) and only 1 patient required repeat resection during a median follow-period of 24.9 months. ConclusionsThe transcortical approach is a safe alternative corridor for accessing giant, falcine meningiomas and postoperative seizures were not found to correlate with increasing corticectomy depth. Further prospective studies are necessary to determine the best approach to these surgically complex lesions.