Occipital interhemispheric approach for surgical removal of the middle third falx meningioma: Two case reports

Obtaining adequate working space is difficult for complete and safe resection of meningioma located in the middle third of the falx, because of the risk of damage to the bridging veins that flow into the superior sagittal sinus and the location near the eloquent area. Consequently, surgical resection of the meningioma in the middle third of the falx tends to result in neurological disorders caused by retraction of the brain and injury of the bridging vein. Two patients underwent tumor removal of the falx meningiomas located in the middle third of the falx through the occipital interhemispheric approach (OIA) in the lateral semiprone position with the affected side down. Tumor resection was achieved safely and less invasively. Both patients suffered numbness and motor weakness, but these neurological dysfunctions improved and clinical courses were uneventful. Postoperative computed tomography showed neither brain swelling nor contusion in both cases. The OIA can remove tumor in the middle third of the falx, because the approach avoids the bridging veins, and provides working space without excessive mechanical cerebral retraction.