FALCINE MENINGIOMA & FALX MENINGIOMA

Falcine Meningioma & Falx Meningioma

Falcine or falx Meningiomas are deep midline tumors arising from the Falx Cerebri. The falx is this large midline meningeal fold between both cerebral hemispheres. As the tumor grows it can press on the adjacent brain on the inner aspect of either cerebral hemisphere. Tumor growth can cause swelling or edema of the adjacent brain and lead to neurological symptoms and disability. Falcine Meningiomas can be located in the frontal, parietal or occipital region along the falx in the midline.

Symptoms

Frontal falcine Meningioma at the mid part of the falx can present with focal motor or sensory seizure on the contralateral side of the tumor. Patients can also develop progressive foot and leg weakness or sensory loss. Occipital falcine Meningioma located in the back part of the falx can present with loss of peripheral vision on the contralateral side of the tumor.

Treatment

Symptomatic falx Meningiomas are generally treated with surgery. Small to medium size incidental tumors without associated brain edema can be treated with observation and surveillance MRIs. Elderly patients with small to medium size tumors associated with mild symptoms and without significant mass effect can be treated primarily with CyberKnife or Proton Bean radiation therapy.

Surgical Treatment at the Meningioma Center

In the Meningioma Center falcine Meningioma is treated with the smallest possible incision and bone opening in the skull (craniotomy) next to the midline. The craniotomy is tailored to the location and size of the tumor. The size of the craniotomy and localization of the tumor is guided by a computer-assisted device that can pinpoint the site and anatomy of the tumor (Stealth Station or BrainLab Station). Occasionally we use an approach contralateral to the side of the bigger part of the tumor to avoid manipulation of the swelled and compromised brain around the tumor.

Tumor resection is carried out with magnification with the surgical microscope to allow elevation of the tumor away from the underlying brain following natural anatomical planes of dissection. This strategy avoids unnecessary trauma or damage to the brain tissue. The tumor is removed and dissected in a piecemeal fashion after breaking the tumor with an ultrasonic device which decreases the tumor pressure and facilitates its dissection. The origin of the tumor in the falx is routinely removed. Any tumor in the contralateral side of the flax is dissected away from the adjacent brain and removed. This strategy maximizes complete resection of the tumor

Prognosis

Treatment of falcine Meningiomas through focused small craniotomies and microsurgical technique improves chances of maximal tumor removal with function preservation or recovery of motor function. Pre-operative seizures are often well controlled with or without medication after atraumatic tumor resection.

Small surgical openings or craniotomies decrease the duration of surgery, soft tissue trauma and swelling, post-operative pain, and hospital stay. Adequate Treatment of falcine Meningiomas enhances the potential for patients to return to their lifestyle and job occupation. Maximal removal of the tumor including the falx meningeal origin of the tumor maximizes the chances of patient progress without tumor recurrence.