Transcranial resection of falcine meningiomas by complete endoscopy with the assistance of intraoperative ultrasound

Transcranial neurosurgery assisted by endoscopy and intraoperative ultrasound (IOUS) has become an effective approach for real-time visualization and guidance during tumor resection. This study explores the application of these techniques in falcine meningioma (FM) resection, assessing their feasibility and safety. Eleven FM patients underwent transcranial endoscopic resection with IOUS assistance. Preoperative neuroimaging, including magnetic resonance (MR) imaging, computed tomography, MR angiography, and MR venography, guided surgical planning. IOUS provided real-time tumor localization, boundary visualization, adjacent structure assessment, and guidance throughout the resection. Tumors were located in the anterior, middle, and posterior falx in 4, 5, and 2 patients, respectively. Of the 11 cases, 8 involved unilateral falx tumors and 3 involved bilateral falx tumors. Simpson grade 1 resection was achieved in 12 patients; one case involved a deeply located tumor closely associated with the deep venous plexus. Pathologically, 10 patients had World Health Organization (WHO) grade 1 meningiomas, and 1 had a WHO grade 3 anaplastic meningioma. Postoperative complications included temporary contralateral hemiplegia in one patient and pulmonary infection in another. The average follow-up period was 19.3 months, with all patients achieving Karnofsky Performance Status scores of > 90. In conclusion, endoscopic resection with IOUS assistance is both feasible and safe for FM patients.