Falcine and Parasagittal Meningiomas

Meningiomas are the brain’s most common primary tumor, representing over one-third of all intracranial tumors. The most common location is the cranial convexity, followed by the parasagittal area (20-30%), while those arising from the falx are less common (about 8%). Parasagittal (PM) and falcine (FM) meningiomas represent a true challenge for the neurosurgeon because of their potential to invade critical venous structures (e.g., the superior or the inferior sagittal sinus), the presence of major cortical draining veins, and the close relationship with eloquent areas. All these factors often impede a complete or gross total resection and increase the risk of recurrence. Additionally, PMs and FMs show an extreme histological heterogeneity, and account for the highest rate of high-grade lesions (WHO grade 2 and 3) among intracranial meningiomas. This chapter provides a discussion of the epidemiology, clinical and radiological features, relevant anatomy, and treatment strategies for PMs and FMs, analyzing the outcomes of 2070 patients harboring 1387 PMs and 488 FMs in 29 studies. Additionally, we here provide the original Institutional surgical series on 125 patients and the experience with stereotactic radiosurgery on 172 patients. This review aims to enhance understanding and guide tailored management strategies for PMs and FMs.