Falcine Meningiomas: Analysis of the Impact of Radiologic Tumor Extensions and Proposal of a Modified Preoperative Radiologic Classification Scheme

• Published in: World neurosurgery Vol. 104; pp. 248 - 258
• Main Authors: Das, Kuntal Kanti, Gosal, Jaskaran Singh, Sharma, Pradeep, Mehrotra, Anant, Bhaisora, Kamlesh, Sardhara, Jayesh, Srivastava, Arun, Jaiswal, Awadhesh Kumar, Kumar, Raj, Behari, Sanjay
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2017
• Subjects: Contralateral; Dura Mater - diagnostic imaging; Dura Mater - pathology; Dura Mater - surgery; Falx; Female; Humans; Image Interpretation, Computer-Assisted - methods; Magnetic Resonance Imaging; Male; Meningeal Neoplasms - diagnostic imaging; Meningeal Neoplasms - pathology; Meningeal Neoplasms - surgery; Meningioma - diagnostic imaging; Meningioma - pathology; Meningioma - surgery; Middle Aged; Outcome; Parasagittal meningioma; Reproducibility of Results; Sensitivity and Specificity; Surgery; Treatment Outcome; Venous sinus; WHO grade; TCR; OR; Falx; CI; FM; WHO grade; PSM; CEMRI; SSS; Contralateral; Outcome; Surgery; Parasagittal meningioma; Venous sinus
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2017.04.159

Although extensively studied, few papers have specifically addressed the surgical implications of horizontal and vertical tumor extensions in falcine meningioma (FM). The available classification systems do not address these tumor extensions and thus do not characterize FM in their entirety. To determine the influence of radiologic tumor extensions on the clinicoradiologic and surgical aspects of FM, propose a new preoperative radiologic scheme for these tumors, and report our surgical outcomes. Thirty-five patients with FM (mean age, 50.03 years; male/female ratio, 16:19) were classified into unilateral conventional (type I; n = 17), unilateral high (type II; n = 9) and bilateral FM (type III; n = 9) based on the coronal magnetic resonance imaging findings. We excluded the primary parasagittal meningiomas from our analysis. Type II and III tumors were more common in males (unlike the overall cohort), presented more often with seizures, and were associated with less favorable postoperative outcomes. Preoperative motor weakness was almost exclusively seen with the unilateral tumors (type I/II). Preexisting weakness (P = 0.02) was a strong predictor of the likelihood of postoperative motor power worsening, the major surgical complication in our series (n = 9; 25.7%). New-onset postoperative weakness (n = 2) recovered completely, whereas worsening of the preexisting weakness showed only a partial improvement (n = 6). The proposed classification scheme characterizes FMs comprehensively. Bilaterality and parasagittal extensions in FMs affect their clinical presentation, increase surgical difficulty, and influence the surgical outcome adversely. Preexisting motor weakness portends a poor postoperative motor outcome.