Endoscopic Contralateral Interhemispheric Transfalcine Keyhole Approach for Large Falcine Meningiomas
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Published on: July 5, 2021
Yuki Sakaeyama1, Hiroki Morisako2, Hiroki Ohata1
1Department of Neurosurgery, Osaka City University Graduate School of Medicine, Osaka, Japan.
Objective:
Falcine meningioma is usually approached ipsilaterally, and the technique for tumor removal has traditionally been performed under microscopy. We report a surgical procedure for large falcine meningioma by an endoscopic contralateral interhemispheric transfalcine keyhole approach.
Methods:
The study period was from September 2019 to March 2021. Study participants were patients with World Health Organization grade I meningioma showing falx attachment, excluding neurofibromatosis, who underwent initial surgery at our institution. The surgical procedure begins with a small contralateral craniotomy of about 3 cm, followed by insertion of an endoscope. The tumor attachment to the falx is excised, exposing the tumor. Internal decompression is performed, and the lesion is dissected from the surrounding brain before removal through the falx.
Results:
An endoscopic contralateral interhemispheric transfalcine keyhole approach was used to resect 4 cases of large falcine meningioma. The mean operation time was 265 minutes (range: 216-294 minutes), achieving Simpson grade I removal in all cases. No evidence of cerebral infarction, cerebral edema, or new neurological complaints related to impaired venous return was seen using this surgical method.
Conclusions:
In the case of falcine meningioma, the endoscopic keyhole contralateral technique allows detachment of the tumor from the falx and safe manipulation in a minor field of view. In addition, because the craniotomy is smaller and the operation time is shorter, this procedure offers a less-invasive approach for the patient. This technique is thus, in our opinion, quite advantageous.
Insights
This study introduces an endoscopic contralateral keyhole approach for large falcine meningiomas, offering a less-invasive surgical option. The technique achieved complete tumor removal with no adverse events in four patients.
Area of Science:
- Neurosurgery
- Surgical Oncology
- Minimally Invasive Procedures
Background:
- Falcine meningiomas traditionally undergo ipsilateral microsurgical resection.
- Large falcine meningiomas present unique surgical challenges due to their location and size.
Purpose of the Study:
- To describe and evaluate a novel endoscopic contralateral interhemispheric transfalcine keyhole approach for large falcine meningiomas.
- To assess the safety and efficacy of this minimally invasive technique.
Main Methods:
- A prospective study involving patients with World Health Organization grade I meningioma with falx attachment.
- The procedure involved a small contralateral keyhole craniotomy, endoscopic tumor resection, and dissection from the surrounding brain.
- Four patients underwent this novel surgical approach between September 2019 and March 2021.
Main Results:
- Complete tumor resection (Simpson grade I) was achieved in all 4 cases.
- The mean operative time was 265 minutes, with no instances of cerebral infarction, edema, or venous compromise.
- The endoscopic keyhole approach facilitated safe tumor detachment and manipulation.
Conclusions:
- The endoscopic contralateral interhemispheric transfalcine keyhole approach is a safe and effective minimally invasive option for large falcine meningiomas.
- This technique allows for safe tumor removal with reduced invasiveness compared to traditional methods.
- The approach offers advantages including smaller craniotomy and potentially shorter operation times.
