Related Experiment Video
Updated: Dec 24, 2025
Role of Diffusion MRI Tractography in Endoscopic Endonasal Skull Base Surgery
Published on: July 5, 2021
Is Falcine Meningioma a Diffuse Disease of the Falx? Case Series and Analysis of a "Grade Zero" Resection
Michael A Mooney1,2, Mohammad Abolfotoh3,4, Wenya Linda Bi2
1Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona.
Background:
Falcine meningiomas have unique characteristics including their high rates of recurrence, association with high grade pathology, increased male prevalence, and potential for diffuse involvement of the falx.
Objective:
To address these issues in a substantial series of falcine meningiomas and report on the impact of extent of resection for this distinct meningioma entity.
Methods:
Retrospective analysis of characteristics and outcomes of 59 falcine meningioma patients who underwent surgery with the senior author. A "Grade Zero" category was used when an additional resection margin of 2 to 3 cm from the tumor insertion was achieved.
Results:
For de novo falcine meningiomas, gross total resection (GTR) was associated with significantly decreased recurrence incidence compared with subtotal resection (P ≤ .0001). For recurrent falcine meningiomas, median progression-free survival (PFS) was significantly improved for GTR cases (37 mo vs 12 mo; P = .017, hazard ratio (HR) .243 (.077-.774)). "Grade Zero" resection demonstrated excellent durability for both de novo and recurrent cases, and PFS was significantly improved with "Grade Zero" resection for recurrent cases (P = .003, HR 1.544 (1.156-2.062)). The PFS benefit of "Grade Zero" resection did not achieve statistical significance over Simpson grade 1 during the limited follow-up period (mean 2.8 yr) for these groups.
Conclusion:
The recurrence of falcine meningiomas is related to the diffuse presence of tumor between the leaflets of the falx. Increased extent of resection including, when possible, a clear margin of falx surrounding the tumor base was associated with the best long-term outcomes in our series, particularly for recurrent tumors.
Insights
Complete resection of falcine meningiomas, especially "Grade Zero" resection, significantly reduces recurrence and improves progression-free survival (PFS). This approach is crucial for managing these challenging brain tumors.
Area of Science:
- Neurosurgery
- Oncology
- Pathology
Background:
- Falcine meningiomas present unique challenges, including high recurrence rates, association with high-grade pathology, male predominance, and diffuse involvement of the falx.
- These characteristics necessitate specific surgical considerations and outcome assessments.
Purpose of the Study:
- To analyze a substantial series of falcine meningiomas.
- To report on the impact of the extent of surgical resection on recurrence and survival for this distinct meningioma entity.
Main Methods:
- Retrospective analysis of 59 patients with falcine meningiomas who underwent surgery.
- Classification of resection extent, including a
- Grade Zero
- category for achieving a 2-3 cm clear margin from tumor insertion.
- Evaluation of recurrence rates and progression-free survival (PFS).
Main Results:
- Gross total resection (GTR) significantly decreased recurrence for de novo falcine meningiomas compared to subtotal resection (P ≤ .0001).
- For recurrent meningiomas, GTR significantly improved median PFS (37 months vs. 12 months; P = .017).
- "Grade Zero" resection demonstrated excellent durability and significantly improved PFS for recurrent cases (P = .003).
Conclusions:
- Falcine meningioma recurrence is linked to diffuse tumor infiltration within the falx.
- Increased extent of resection, including a clear margin of the falx, is associated with the best long-term outcomes, particularly for recurrent tumors.
