Falcotentorial Meningioma

Resection of a Giant Falcotentorial Meningioma

Only about 50 cases of falcotentorial meningiomas have been reported in the literature. These masses arise from the junction of the tentorium and falx cerebri, either anteriorly at the junction of the vein of Galen with the straight sinus or anywhere along the length of this junction toward the torcula.

The torcula may be predominantly affected; peritorcular meningiomas require a different set of considerations because of the intimate involvement of the major dural sinuses, and they are therefore discussed in their own chapter titled Peritorcular Meningioma.

Meningiomas associated with the tentorial incisura present a considerable number of surgical challenges because of their relationship to the structures involved in the principal deep venous drainage systems of the diencephalon. When the torcula and the occipital lobes are involved, the risk of cortical blindness is significant and should not be underestimated.

With careful patient selection and detailed preoperative assessment, surgical risks can be minimized. Preservation of the patent straight sinus is an important goal during the surgery.

Meticulous surgical technique is mandatory when the surgeon is working in the vicinity of the dural venous sinuses and central venous structures, given the requirement for patency of venous outflow and the risk of life-threatening intraoperative bleeding. The surgeon, of course, wants to achieve complete resection, but that goal ma...