Abstract
Transcranial neurosurgery with the assistance of endoscope and intraoperative ultrasound (IOUS) has emerged as a promising strategy for real-time visualization and guidance during tumor resection. In this study we aimed to explore the application of these techniques in the resection of falcine meningiomas (FM) and to investigate the feasibility and safety. In this report, combination techniques of transcranial endoscope and IOUS were used for the surgical resection in 11 patients with FM. Preoperative neuroimaging tests, including magnetic resonance imaging (MRI), computed tomography (CT), magnetic resonance angiography (MRA), and magnetic resonance venography (MRV) were utilized for the surgical planning. Real-time IOUS assisted the localization, visualization of tumor boundaries, assessment of adjacent structures, and guidance of the resection process. We found that tumors locating in the anterior, middle and posterior third of falx were found in 4, 5, and 2 patients, respectively. Tumors in unilateral falx were 8 cases, and in bilateral falx were 3 cases. Simpson grade I resection was carried out for all the patients. Benign tumor was present in 10 patients, and a patient was with WHO grade III for pathological finding. Postoperative complications occurred in two patients, a patient with temporary contralateral hemiplegia, and another patient with pulmonary infection. The average time of follow-up was 19.3 months. All patients had Karnofsky Performance Status (KPS) scores > 90 scores. In summary, the combination of endoscope and IOUS was feasible and safe for FM patients, especially for those with deep seated FMs.