How I do it: meningioangiomatosis of the sylvian fissure. The need for a tailored functional neurosurgery.

BACKGROUND

Meningioangiomatosis is a formidable neurosurgical challenge due to its heterogeneous nature and anatomical localization which often make impossible gross total resection. Surgery is reserved for drug-resistant epileptic seizures aiming their control.

METHOD: We describe a case of meningioangiomatosis of the right sylvian fissure involving the M1-M2 segments of right middle cerebral artery. A subtotal lesion resection, completed with disconnection surgery through multiple subpial circumferential transections was performed.

CONCLUSION

To underline the efficacy of the disconnection surgery and the pivotal role of intraoperative electrophysiologic assessment for tailoring the surgical resection at the presumed ictal onset zone.