Total removal of a falcotentorial junction meningioma by biparietooccipital craniotomy in the sea lion position: a case report.

The successful total removal of a huge falcotentorial junction meningioma in a 59-year-old woman by biparietooccipital craniotomy with the patient in the sea lion position (prone with a hyperextended neck and with 20 degrees elevation of the upper and lower halves of the body) is reported, with some comments on the advantages of this approach and position. Taking advantage of the exposure of the dural sinus, the confluens sinuum pressure was measured by direct catheterization with the patient in various positions. The pressure was 3.6 cm H2O in the sea lion position, 2.4 cm H2O in the reverse jackknife position (supine with 20 degrees elevation of the upper and lower halves of the body), and -12 cm H2O in the sitting position.