The Classification And Surgical Planning Of Bilateral Cerebral Falcine Meningiomas

Objective:To probe into the classification of bilateral cerebral falcine mengingiomas (BCFMs), study the characteristics, surgical planning of BCFMs.Method:Based on a series of1503patients with intracranial meningioma treated between Jan2002and Dec2012in Qilu Hospital affiliated to Shandong University is analyzed retrospectively. Study the general information, clinical manifestation, imaging characteristics, pathological findings, operation and postoperative status of these patients with BCFMs. A classification system of BCFMs was proposed according to the tumors’ bases, symmetry and distance between the bases of bilateral tumors and the surgical planning was determined.Results:In the statistics of1503patients with meningiomas,117cases are falcine mengingiomas (accounts for about7.78%of the total), and31cases are BCFMs (accounts for about26.5%of the number of patients of falcine meningiomas),16patients were male and15female. Patients’ age varied from20to81(mean age is54.1). Course of disease were between1week to9years (mean time is1.9years). All of the tumors are based on the falcine and grow in different directions.15cases invasion upwards superior sagittal sinus,6cases invasion downwards inferior sagittal sinus or oppression corpus callosum,1case coating pericallosal artery,1case invasion outwards endocranium and skull. Main clinical manifestations included headache and dizzy (23cases), nausea and vomit (5cases), hemiplegic paralysis (17cases), paraplegia (2cases), acroparesthesia (3cases), convulsion (4cases), visual loss and (or) visual field defects (6cases), memory deterioration (3cases), personality changes (1case), asymptomatic patient which find tumor after head injury (1case). Simpson grade I resections were achieved in23cases, Ⅱ in4, Ⅲ in4, and Ⅳ in0. No perioperative death occurred. Symptoms of all patients were recovered well, reduce or disappear. Postoperatively, follow-up was done for3months to3years in all patients. No tumor recurrence was observed during follow-up period.Conclusion:Based on the analysis of31patients with BCFMs, a classification scheme for BCFMs has been proposed. According to whether or not the tumors share one basement, the symmetry of tumors" basement and distance between tumors" basement, BCFMs in these series were classified into four types:Type I A, symmetrical tumors sharing one basement (6patients); Type I B, asymmetrical tumors sharing one basement (23patients); Type Ⅱ A, long distance between tumors sharing no basement (1patient); Type ⅡB, close distance between tumors sharing no basement (1patient). The classification system has certain reference values to determine the surgical planning and improve the operative effect.