Let's review the methods for resection of Giant Parafalcine Meningiomas. This is a 42 year old homeless male who was found unresponsive, most likely due to a seizure. MRI evaluation revealed a giant parafalcine meningoma in anterior one Again, you can see the extension of the tumor toward the deeper structures with mild Some of the T2 flow voids localized the location of the calcium marginal and Pericallosal arteries. Obviously the encasement of this giant tumor for the vascular structures can be a high risk factor for removal of the mass. CT Angiogram demonstrated the engulfment of the vascular structures and the encasement of these structures by the tumor. Pericallosal as well as the calcium marginal vessels appear to be within the tumor mass It's Pincher resection using a bilateral funnel parasagittal craniotomy. You can see tuber holes were placed over this parasagittal sinus and a bilateral generous craniotomy was elevated. A lumbar drain was also installed at the beginning of the procedure for early brain decompression. I believe this maneuver especially important. Next, I enter the interim excess space on the right side, the tumor was generously de-vascularized along the falx, the pericallosal as well as calcium marginal arteries were identified Here was a view of the calcium marginal artery. The tumor, however, was first debarked. Here, you can see a branch of calcium marginal artery, and I continued to follow the vessel and remove tumor around the vessel, understanding the principle that this is going to be very challenging as the tumor has to be removed piece by piece around the vessel while protecting the artery. Ample amount of Papaverine solution was used to irrigate the operative space, so the vessel is not in vasospasm. Here you can see it, a lateral nodule of the tumor that is being mobilized more medially so that the vessel can be further pursued. as it enters the heart of the tumor. Here, you can see the continuation of microsurgery, small amount of bleeding from one of the perforating branches of the vessel was encountered. Bipolar coagulation was minimized, and a piece of cotton was used with gentle tamponade to achieve hemostasis. Here's a sizable piece of tumor after the vessel has been mobilized more laterally. The tumor is mobilized from posterior to anterior direction. So I can at least estimate that this whole location of the Pericallosal artery. This piece is being delivered. It was Corpus callosum. Now I have divert my attention towards the left side, where a similar maneuver is pursued in terms of working around the vessels to remove the tumor fragments. The portion of the falx that is affected by the tumor was resected. Again, it's important to preserve all the surrounding vessels. I used Doppler ultrasonography to inspect the location of the vessels and their patency during various resection maneuvers. This vessel entered the tumor, and I could not find its distal end and therefore that small branch of the pericallosal artery was sacrificed. Postoperative MRI demonstrated complete removal of the mass and the affected part of the falx without any evidence of ischemia in the distal, calcium marginal and pericallosal arteries. Thank you.
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