Surgical treatment of parasagittal and falx meningiomas

We present our experience with surgery of parasagittal and falx meningiomas with special consideration of surgical outcome and risk of recurrence.

A series of 87 consecutive patients surgically treated for parasagittal and falx meningiomas is reported. 50 patients had parasagittal meningiomas and a further 37 had falx meningiomas. Meningioma invaded the superior sagittal sinus in 21 cases. According to Simpson's scale, 25 procedures were Grade I resection, 55 were Grade II resection and 7 were Grade IV resection. Among 21 patients with parasagittal meningiomas invading the sagittal sinus, radical resection of the tumour and invaded part of sinus was made in 9 cases.

Seven patients were severely disabled and 4 patients died after the surgery whereas 76 patients had satisfactory outcome on discharge. At the time of analysis, 14 patients had shown evidence of recurrence. Male gender, partial removal of meningioma (Simpson Grade IV) and bilateral falx meningioma had a statistically significant influence on recurrence. There were no tumour recurrences following radical resection of the tumour and invaded part of sinus, but two postoperative deaths due to haemodynamic complications were noted. In the other 12 patients, meningiomas were removed but sinus infiltration was left in place; the postoperative period was uneventful but the rate of clinically important regrowth in this group of patients was 25% in long-term follow-up.

Rate of recurrence of parasagittal and falx meningioma significantly increases in cases of non-radical resection of tumour. Aggressive surgical treatment presents several hazards and carries an increased risk of unsatisfactory outcome; the risk of recurrence, however, is significantly decreased.