Right Anterior Parasagittal Craniotomy and Interhemispheric Approach for Resection of a Falcontentorial Junction...

Falcotentorial meningiomas are rare lesions that occur along the midline at the junction of the falx cerebri and tentorium. When large, these lesions pose a surgical challenge because of the risk of neurologic deficits, including cortical blindness. Delicate structures at risk during resection of these lesions include the sagittal sinus, internal cerebral veins, vein of Galen, straight sinus, torcula, and fornix. Although there are a number of very reasonable approaches, including a supracerebellar infratentorial or occipital interhemispheric, we chose an anterior interhemispheric approach to provide the safest route for accessing the largest portion of the tumor while protecting the deep venous system.  After identification of the falcine attachment, the tumor is debulked within the tumor capsule. In this case, the tumor was subtotally removed because of the adherence of a small segment of tumor along the vein of Galen. The patient gave informed consent for surgery and video recording. Institutional review board approval was deemed unnecessary. Used with permission from Barrow Neurological Institute.