What are the expected clinical findings of a low frontal lobe falcine meningioma located around the area of the sylvian fissure?

Expected Clinical Findings of Low Frontal Lobe Falcine Meningioma Near the Sylvian Fissure

A low frontal lobe falcine meningioma extending toward the sylvian fissure region will most commonly present with seizures (occurring in up to 30% of cases), motor deficits affecting the contralateral limbs, and symptoms of raised intracranial pressure including headaches, drowsiness, and vomiting. 1

Primary Clinical Manifestations

Seizure Activity

• Epilepsy is a presenting symptom in up to 30% of meningiomas, particularly those involving the frontal lobe and perisylvian regions 1
• Temporal lobe epilepsy patterns may occur when the tumor extends toward or involves the sylvian fissure 2
• Seizures may be the sole presenting symptom in some cases, particularly with smaller tumors 2

Motor and Sensory Deficits

• Focal neurological deficits affecting the limbs are common presenting symptoms, with the specific pattern depending on the exact tumor location and extent 1
• Preexisting motor weakness is a strong predictor of postoperative motor power worsening and portends poor motor outcomes 3
• Hemiparesis may develop, particularly with tumors extending laterally toward the sylvian region 4
• Contralateral weakness is more common with unilateral falcine meningiomas 3

Raised Intracranial Pressure

• Headaches, drowsiness, and vomiting are common presenting symptoms due to mass effect 1
• These symptoms are particularly prominent with larger tumors, which tend to be more common at presentation in both pediatric and adult populations 1
• Papilledema may be present on fundoscopic examination 5

Location-Specific Considerations

Falcine Extension Patterns

• Bilateral falcine meningiomas (type III) and those with parasagittal extensions present more commonly with seizures and are associated with less favorable postoperative outcomes 3
• Unilateral high falcine meningiomas (type II) extending vertically also show similar patterns 3
• Horizontal and vertical tumor extensions significantly influence clinical presentation and surgical difficulty 3

Sylvian Fissure Involvement

• Deep sylvian meningiomas without dural attachment represent a rare subgroup that poses both radiological and neurosurgical challenges 4, 2
• These tumors may be firmly adherent to the middle cerebral artery and its branches 2
• Temporal lobe symptoms may predominate when the tumor extends into or near the sylvian fissure 2

Radiological Findings

MRI Characteristics

• MRI is the radiological imaging modality of choice, showing superficial, hemispheric isointense or hypointense masses on T1-weighted images and hyperintense masses on T2-weighted images 1, 5
• Strong and uniform contrast enhancement with the characteristic "dural tail sign" is typical 1, 5
• Peritumoral edema occurs in 40-80% of cases, particularly with large tumors 1
• Cortical buckling and displacement of cortical vessels are diagnostic clues 1

CT Findings

• Isodense or hypodense lesions with possible calcifications (up to 50% of cases) 1
• Hyperostosis may be present, particularly in skull-based extensions 1
• Calcifications are more common in pediatric meningiomas 1

Important Clinical Pitfalls

Diagnostic Challenges

• Not all enhancing dural-based lesions are meningiomas—brain metastases, gliomas, and primary CNS lymphoma can mimic meningiomas 5
• Deep sylvian meningiomas may lack typical dural attachment, making radiological diagnosis more difficult 4, 2
• The "dural tail sign" is characteristic but not pathognomonic 1

Prognostic Factors

• Male predominance and bilateral involvement are associated with more aggressive behavior and worse outcomes 3
• Preexisting motor weakness strongly predicts likelihood of postoperative motor deterioration (P = 0.02) 3
• Tumors tend to be larger at presentation, increasing surgical complexity 1

Cranial Nerve Involvement

• Cranial nerve palsies are common presenting symptoms depending on tumor extension 1
• Visual deficits may occur with anterior extension 1
• Multiple cranial nerves may be affected with extensive tumors 1

Age and Gender Considerations

• In adults, there is typically a female predominance (3:2), but this pattern may vary with specific locations 1
• Pediatric meningiomas show male predominance and tend to be larger at presentation with more frequent calcifications and cystic transformation 1