The falcotentorial and velum interpositum meningiomas can be safely managed with the use of occipital transtentorial approach. Homonymous hemianopsia is the most common although always transient complication of surgery.
The extent of tumor removal had no effect on the risk of recurrence, and thus it may be acceptable to leave tumor capsule fragments adhering closely to nerves, vessels, or brainstem. During long-term follow-up, resolution or improvement of present preoperatively and new postoperative neurological deficits may be expected in most patients.
In our series, the factors related to size and side of the tumor confirmed an independent impact on CNVII-IDR and CNVIILTF. The significance of patient positioning may reflect the impact of learning curve as only the first 91 patients were operated on using the lateral "park-bench" position. An independent impact on CNVII-LTF was exerted by the perioperative use of nimodipine.
Pial invasion is an important predictor of tumor recurrence in benign and atypical meningiomas. In atypical meningiomas bone involvement and large peritumoral brain edema are associated with increased tumor progression.
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