Management of Falcotentorial Meningiomas

Meningiomas are the most frecuent benign tumor of the central nervous system. 30–40% originate from the skull base. Aproximately 9% arise from the posterior fossa and 30% of these originate from the tentorium. According to Yasargil and Al-Mefty´s classifications these tumors may be: a) medial to the free tentorial edge b) paramedial to the free tentorial edge c) surrounding the torcula d) lateral and e) falcotentorial. Of all the tentorial meningiomas included in our series we are specifically analazing the management of a group of 5 falcotentorial meningiomas. All cases were considered large meningiomas at the moment of diagnosis averaging 4.1 cm in its maximal diameter. One case presented a postoperative hemiparesis due to a postero medial choroidal artery lesion and a mortality of 0%. All cases graded Simpson 1 resection. In our review we include clinical and radiological pearls, anatomic review of the tentorial fold and cuadrigeminal cistern, surgical positioning and the surgical supra infra tentorial approach step by step. We present a video that displays the tips and tricks to handle these tumors.