BACKGROUND Falcine meningiomas have unique characteristics including their high rates of recurrence, association with high grade pathology, increased male prevalence, and potential for diffuse involvement of the falx. OBJECTIVE To address these issues in a substantial series of falcine meningiomas and report on the impact of extent of resection for this distinct meningioma entity. METHODS Retrospective analysis of characteristics and outcomes of 59 falcine meningioma patients who underwent surgery with the senior author. A "Grade Zero" category was used when an additional resection margin of 2 to 3 cm from the tumor insertion was achieved. RESULTS For de novo falcine meningiomas, gross total resection (GTR) was associated with significantly decreased recurrence incidence compared with subtotal resection (P ≤ .0001). For recurrent falcine meningiomas, median progression-free survival (PFS) was significantly improved for GTR cases (37 mo vs 12 mo; P = .017, hazard ratio (HR) .243 (.077-.774)). "Grade Zero" resection demonstrated excellent durability for both de novo and recurrent cases, and PFS was significantly improved with "Grade Zero" resection for recurrent cases (P = .003, HR 1.544 (1.156-2.062)). The PFS benefit of "Grade Zero" resection did not achieve statistical significance over Simpson grade 1 during the limited follow-up period (mean 2.8 yr) for these groups. CONCLUSION The recurrence of falcine meningiomas is related to the diffuse presence of tumor between the leaflets of the falx. Increased extent of resection including, when possible, a clear margin of falx surrounding the tumor base was associated with the best long-term outcomes in our series, particularly for recurrent tumors.

中文翻译：

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镰状脑膜瘤是镰状细胞的弥漫性疾病吗？“零级”切除病例系列与分析

背景镰状脑膜瘤具有独特的特征，包括其高复发率、与高级别病理相关、男性患病率增加以及大脑镰弥漫性受累的可能性。目的在一系列大量的镰状脑膜瘤中解决这些问题，并报告切除范围对这一独特脑膜瘤实体的影响。方法 与资深作者一起回顾性分析 59 例接受手术的镰状脑膜瘤患者的特征和结局。当从肿瘤插入处获得 2 至 3 厘米的额外切除边缘时，使用“零级”类别。结果 对于新发镰状脑膜瘤，与次全切除相比，大体全切除 (GTR) 与显着降低的复发率相关 (P ≤ .0001)。对于复发性镰状脑膜瘤，GTR 病例的中位无进展生存期 (PFS) 显着改善（37 个月 vs 12 个月；P = .017，风险比 (HR) .243 (.077-.774)）。“零级”切除术在新发病例和复发病例中均表现出优异的耐久性，对于复发病例，“零级”切除术可显着改善 PFS（P = .003，HR 1.544 (1.156-2.062)）。在这些组的有限随访期间（平均 2.8 年），“零级”切除术的 PFS 获益没有达到辛普森 1 级手术的显着统计学意义。结论镰状脑膜瘤的复发与镰状叶之间弥漫性肿瘤的存在有关。增加切除范围，包括在可能的情况下，