Systematic Review and Pooled Analysis of Falcotentorial Meningiomas: Clinical Features, Surgical Techniques, and Postoperative Outcomes

Falcotentorial meningiomas (FTMs) account for a small proportion of intracranial meningiomas. They originate from the falcotentorial junction, a region where critical venous structures and deep brain regions intersect, making surgical resection challenging. Current literature on FTM consists mainly of isolated case reports and small case series, focusing primarily on surgical techniques. This systematic review aims to consolidate and analyze the clinical characteristics, surgical approaches, and outcomes of FTM cases to offer evidence-based insights that can guide clinicians in managing this rare type of meningioma more effectively. A comprehensive literature search was conducted using PubMed, Scopus, and Web of Science databases to identify case reports and case series on FTM. Articles were included if they provided detailed clinical, surgical, and outcome data. The primary outcome was the incidence of postoperative visual field defects across different surgical approaches. Secondary outcomes included systemic complications, tumor recurrence, and mortality. The analysis included 127 patients (mean age 55 years, 51.3% male). The most common presenting symptom was headache (81.8%), followed by gait disturbances (21.1%) and dizziness (19.5%). About 49.4% of tumors were grade I, while grade II tumors were present in 5.2% of cases. The occipital interhemispheric transtentorial approach was used in 36.4% of cases. Postoperative visual field defects were observed in 12.3% of cases, with the occipital interhemispheric transtentorial being the most associated with higher rates of visual complications (p < 0.001). Recurrence occurred in 8.4% of patients, while the overall mortality rate was 1.3%. FTMs pose significant challenges due to their complex location and proximity to critical structures. This study highlights the need for further research to refine surgical techniques and improve long-term outcomes for patients diagnosed with FTM.