Parasagittal and parafalcine cystic meningiomas, as well as other cystic meningiomas case series and systematic literature review.

Cystic components in meningiomas are an infrequent finding and pose diagnostic and therapeutic challenges to neurosurgeons.  A prospective evaluation was conducted on ۱۳۴ patients with meningioma between ۲۰۲۰ and ۲۰۲۳. Four cases of cystic meningioma were analyzed at Al-Thawra Model General Hospital in Sana'a, Yemen. A systematic literature review identified three significant studies, and included patient age, gender,clinical presentation, neurological deficit, radiological site, morphological of cyst, histopathological type. In the first case (case ۱), parasagittal cystic meningioma was detected on brain MRI with gadolinium enhancement. In the second case (case ۲), parafalcine cystic meningiomas showed typical dural tail and base on brain MRI, along with the cysts surrounded by edema and gadolinium tumor enhancement. In cases ۳ and ۴, convexity cystic meningioma with gadolinium tumor enhancement on brain MRI was detected. All tumors were removed surgically at stage ۱ (Simpson stage), and histopathology confirmed WHO grade ۱ syncytial meningioma in cases ۱, ۳, and ۴. Only case ۲ showed grade ۳ rhabdoid meningioma. In conclusion, we found that benign cystic meningiomas may cause more brain edema than high-grade meningiomas, especially when they invade the sinus. Parasagittal and parafalcine cystic meningiomas invade the superior sagittal sinus (SSS), which makes complete excision more challenging and riskier.