From the Research
For a 19 mm frontal lobe meningioma with intimate contact with the left margin of the falx and sagittal sinus but without invasion or surrounding edema, observation with serial imaging is the recommended initial management approach. The patient should undergo MRI scans with contrast every 6-12 months for the first 1-2 years, then annually for 3-5 years if stable. This conservative approach is appropriate because most small meningiomas (under 2-3 cm) without symptoms grow very slowly, if at all, and the proximity to critical venous structures increases surgical risks, as noted in a review of clinicopathological and molecular aspects of meningiomas 1.
Key Considerations
- The tumor's location near the sagittal sinus could complicate complete surgical removal, making observation or stereotactic radiosurgery preferable initially.
- If the patient develops symptoms such as headaches, seizures, or focal neurological deficits, or if follow-up imaging shows significant growth (typically >5 mm increase in diameter per year), then intervention would be warranted.
- The patient should be counseled about potential symptoms that would warrant immediate medical attention, including new-onset seizures, persistent headaches, vision changes, or focal weakness.
Surgical Approach
Surgical management, when necessary, should be approached with caution, considering the anatomical and clinical features of the tumor, as described in studies on the surgical management of falcine meningiomas 2, 3. The use of advanced microsurgical tools and techniques to preserve major cortical veins and the sinus is crucial. However, given the current scenario, a conservative approach with observation and serial imaging is prioritized to minimize risks and preserve quality of life, especially considering the tumor's small size and lack of symptoms or invasion into critical structures.