# Risk factors for motor decline following parasagittal and falx meningioma resection in the middle third

## TL;DR

This study identifies risk factors for motor decline after surgery for meningiomas in a specific brain region, aiming to improve surgical outcomes.

## Contribution

The study identifies specific predictors of postoperative motor decline after resection of parasagittal and falx meningiomas in the middle third of the superior sagittal sinus.

## Key findings

- 14.9% of patients experienced postoperative motor decline after meningioma resection.
- Major venous involvement, falx meningioma, loss of the brain-tumor interface, and WHO grade II-III were significant predictors of motor decline.
- Alternative surgical strategies may help prevent motor decline in high-risk patients.

## Abstract

The resection of parasagittal and falx meningiomas in the middle third superior sagittal sinus (SSS) is associated with a high risk of postoperative motor deficits. This study discusses the risk factors affecting postoperative motor decline and recovery of motor function after follow-up.

The results of a single-institution retrospective cohort study of parasagittal and falx meningioma resection in the middle third between 2016 and 2023 were reviewed, and parameters were screened as potential predictors. Variables of interest included postoperative motor decline and outcome after follow-up. Univariate and multivariate analyses were performed to identify risk factors.

Among 87 patients who underwent resection of parasagittal (63.2%) or falx (36.8%) middle third meningiomas, 14.9% (13/87) experienced postoperative motor decline. Among the 36 patients (41.4%) with preoperative motor deficits, 66.3% improved, 17.0% unchanged, and 16.7% (6/36) worsened following surgery. Among the 51 patients without preoperative motor deficits, 13.7% (7/51) developed new weakness. The predictors of postoperative motor decline were major venous involvement (p = 0.022), falx meningioma (p = 0.031), loss of the brain-tumor interface (p=0.033) and WHO grade II-III (p = 0.032).

The resection of parasagittal and falx meningiomas in the middle third carries a high rate of postoperative morbidity and deserves perioperative planning. Alternative surgical strategies, such as preserving the brain-tumor arachnoid interface and minority residual tumors, may prevent motor decline in a subset of high-risk patients.