Unveiling Parafalcine Meningioma : A Comprehensive Guide to Key Information

1. What is Parafalcine Meningioma?

   Parafalcine meningioma is a type of brain tumor that arises from meninges, the layers covering the brain and spinal cord. These tumors develop in the region adjacent to or along the falx cerebri, which is a fold of dura mater that lies between the cerebral hemispheres. These are the third most deadly meningiomas and account for 11-14% of meningiomas-related deaths.⁽¹⁾

   Most of these meningiomas are benign but can still cause serious harm. These tumors can compress the brain tissue which can lead to neurological symptoms such as weakness and vision changes. There can also be life-threatening effects such as difficulty in breathing.

   The symptoms and treatment options for these tumors may vary depending on factors such as tumor size, location, and potential involvement of surrounding brain structures.

2. Grading of Parafalcine Meningioma

   Like other meningioma types, the grading system is used by healthcare professionals. These grades include:⁽²⁾

   • Grade 1: In grade 1 the tumor is of low-grade, which means they grow slowly. These appear with nearly normal tumor cells.
   • Grade 2: This grade tumor is atypical in appearance and has a high chance of recurrence after removal.
   • Grade 3: These tumors are cancerous and are known to grow rapidly and typically and cannot be removed.

   The treatment involves surgical removal when possible or therapies such as radiation to shrink the tumor.

The exact cause of meningioma including parafalcine meningioma is not fully understood. However, there are several factors and associations, that have been explored in research. It is important to note that while certain factors may be correlated with the development of meningiomas, they do not necessarily establish a direct cause-and-effect relationship.

The potential causes of parafalcine meningiomas include:⁽³⁾

• Genetic Factors: Some of the meningiomas have genetic predisposition. They occur in individuals with genetic syndromes such as neurofibromatosis type 2. However, most of the meningiomas are sporadic.
• Hormonal Influence: Estrogen and progesterone are often present in meningiomas.⁽⁵⁾ This suggests their hormonal influence. This also suggests a higher incidence of meningiomas in women, particularly during hormonal events such as pregnancy and menopause.
• Radiation Exposure: Exposure to ionizing radiation, either from medical treatment or environmental sources has been linked to an increased risk of meningiomas.
• Age and Gender: Meningiomas are most commonly diagnosed in adults and the risk increases with age. Also, the incidence is higher in females due to hormonal factors.
• Obesity: There are higher chances of occurrence of all types of meningiomas in people with higher body mass index. This is because obesity can be linked to a risk of several cancer types.
• Cellular and Molecular Factors: There are specific cellular and molecular factors that may contribute to the development of meningiomas. It can be mutations in certain genes and signaling pathways.
• Immunological Factors: The immune system has a role to play in the development and progression of meningiomas. How the immune system interacts with these tumors provides insight into potential therapeutic strategies.
• Hereditary Syndromes: Certain hereditary syndromes such as multiple endocrine neoplasia type 1, may be associated with an increased risk of developing meningiomas.
• Ethnic and Geographic Variation: Studies suggest variations in meningioma incidence based on ethnic and geographic factors. However, further observation is needed to establish a clear association.

Meningiomas are the complex interplay of genetic, environmental, hormonal, and possible immunological factors. Understating the causes and risk factors is important as it leads to improved prevention and treatment strategies.

The symptoms of parafalcine meningioma may vary depending on the size and location of the tumor as well as the impact on the surrounding brain structures. Common symptoms include: 

• Persistent and severe headaches that may worsen over time and may not be relieved by typical pain medications.
• The meningioma may irritate the brain tissue leading to seizures that may vary in severity and type.
• The cognitive function may be affected leading to changes in memory and other aspects of mental function. This may lead to difficulties with learning, reasoning, or problem-solving.
• The personality and behavior of an individual with parafalcine meningioma may be affected. There may be mood swings, irritability, or alterations in social interactions.
• Depending on the location of the tumor, individuals may experience weakness, numbness, and tingling in the limbs.
• There may be blurred vision, double vision, and visual field defects. This may occur as the parafalcine tumor presses against or involves structures related to vision.
• If the tumor is present near the areas of the brain responsible for language and speech, it may cause difficulty in communication including slurred speech or language impairment.
• Increased intracranial pressure due to a tumor may lead to nausea and vomiting.
• There may be issues with motor coordination leading to disturbance in gait and difficulties with coordination.
• Some individuals may experience alteration in sensations including tingling, numbness, or abnormal sensations in various parts of the body.

The symptoms may vary widely among individuals. Some may experience a combination of these manifestations. Also, slow-growth meningiomas may contribute to the gradual onset of symptoms, making them challenging to recognize in the early stages. Individuals experiencing worsening or persistent neurological symptoms should seek medical attention for proper evaluation and diagnosis.

A thorough medical history is obtained to understand the patient’s symptoms, their duration, and any other medical condition. The doctor conducts a neurological examination to assess motor function, sensory function, reflexes, coordination, and other aspects of brain function.

The following tests are conducted to reach a diagnosis: 

• Magnetic Resonance Imaging (MRI): MRI provides detailed images of the brain and shows the location, size, and characteristics of the tumor.

The contrast used during MRI helps highlight the tumor and its relationship with its surroundings.

• CT Scan: CT scan is used to complement the MRI findings and provides additional information about the tumor’s characteristics, such as calcifications.
• Angiography: Cerebral angiography may be performed to assess the blood supply to the tumor. This can help plan surgical intervention and understand the vascular anatomy around the meningioma.
• Histopathological Analysis: During surgical resection a small tissue sample is taken. It is examined by a pathologist to confirm the diagnosis.

A multidisciplinary team of neurosurgeons, neuro-oncologists, and neuroradiologists collaborated to review the diagnostic findings and determine the most appropriate treatment plan.

A multidisciplinary approach is needed to treat parafalcine meningioma. Small, asymptomatic parafalcine meningioma with low growth may be monitored through regular imaging without immediate intervention. This approach is often considered for those tumors that are not causing significant symptoms or neurological deficits.

Other treatment options include:⁽³⁾

• Surgery: This is a primary treatment option for parafalcine meningiomas, especially those causing symptoms, growing rapidly or those having concern about potential compression of critical brain structures.

The goal of the surgery is to remove as much part of the tumor as possible and preserve neurological functions. What type of surgery is done depends on the location and size of the tumor.

• Radiation Therapy: Adjuvant radiation therapy is considered post-surgery, especially in those cases where complete removal of the tumor is challenging or when there is a risk of recurrence of the tumor.

Stereotactic radiosurgery or fractionated radiotherapy may be used, depending on the specific characteristic of the tumor.

• Chemotherapy: This treatment is recommended if the tumor does not respond to radiation.

A study suggested that radiation and chemotherapy can be potential treatments for parafalcine meningioma for some people.⁽⁴⁾

• Medical Management: Medications may be prescribed for symptom management or side effects related to the tumor or its treatment.

Regular follow-up with imaging studies is essential to monitor any signs of tumor recurrence or progression. This is important in cases where complete surgical removal is not achievable.

Parafalcine meningiomas are tumors that arise along the falx cerebri, a fold of dura mater between the cerebral hemispheres. Mostly the tumor is benign and grows slowly. The symptoms are often observed after the tumor grows into the brain tissue.

What exactly causes the tumor is unknown. The risk factors may include radiation exposure, genetics, and hormonal influence. The symptoms may range from headaches and seizures to cognitive and motor deficits.

Treatment options for parafalcine meningioma include surgery, radiation therapy, and chemotherapy. Regular follow-up is crucial to monitor and manage any potential long-term effects. A collaborative effort of healthcare professionals and individualized patient care plays a vital role in addressing and managing parafalcine meningioma effectively.