Dual parasagittal craniotomy for single-stage resection of non-contiguous falcine meningiomas: A case report

Background: The management of multiple falcine meningiomas located in non-contiguous regions remains challenging, with no established consensus regarding the optimal surgical strategy. Single-stage resection may be limited by surgical access, whereas staged procedures increase overall treatment burden. Case Description: We report the case of a 44-year-old man with no significant medical history presenting with progressive right-sided weakness and a generalized seizure. Imaging revealed two spatially distinct falcine lesions located at the anterior and posterior aspects of the middle third of the falx. A single-stage resection was performed using a dual parasagittal craniotomy (“dual window approach”), allowing direct and independent access to each lesion while preserving the superior sagittal sinus. Gross total resection was achieved, corresponding to Simpson grade II for the anterior lesion due to sinus involvement and Simpson grade I for the posterior lesion. The postoperative course was uneventful, with improvement of the neurological deficit. Conclusion: The dual-window parasagittal approach represents a practical option for selected cases of non-contiguous falcine meningiomas, enabling safe single-stage resection while minimizing venous risk and avoiding extensive exposure. Further studies are needed to define its role in comparison with conventional strategies.