Is sagittal sinus resection in falcine meningiomas a factor of bad surgical outcome?

Abstract

Objective:Meningiomas arising purely from the falx below the longitudinal sinus represents a surgical challenge for the neurosurgeon. The authors discuss the new aspects of surgical details that may avoid complications and determine the prognosis.Materials and Methods:We retrospectively evaluated our surgical experience from June 2004 to January 2010. Seventy patients harboring falcine meningiomas were included and submitted for surgical resection. All historical records, office charts and images were reviewed in order to sample the most important data regarding epidemiology, clinical pictures, radiological findings and surgical results, as well as the main complications. The patients were divided into three main groups: anterior third 32 patients (Group A), middle third 15 patients (Group B), 23 patients in the posterior third of falx (Group C).Results:In Group A, total macroscopic resection was achieved in 31 out of 32 cases (96.87%). Twenty five patients had Rankin 0, five patients had Rankin 1-2, two patients had Rankin 6. In Group B (15 patients), 10 patients had gross resection and Rankin 0, four patients had Rankin 1-2 and one patient had Rankin 6. In Group C (23 patients), 20 patients were absolutely able, Rankin score 0, after six months postoperative period (83.3% had excellent results) and no mortality. Four cases had Rankin score 1 – 2 (16.6%). Ten cases (43.47%) had Simpson I resection and ten cases (43.47%) had Simpson II.Conclusion:Despite larger lesion volumes, Group A meningiomas had a better outcome due to the position they were in, the tumor and surrounding structures. The preoperative preparation and surgical planning can preserve sagittal sinus; but in some cases, this is not possible. Sagittal sinus resection, as proven by this paper, is still a factor of bad surgical outcome. In the middle and posterior third, resection of sagittal sinus is a factor of a bad outcome, due to cerebral infartion.

Parasagittal meningiomas: Our surgical experience and the reconstruction technique of the superior sagittal sinus

“…During the excision of the tumor, it is mandatory to preserve the bridging, especially those of the rolandic area through their dissection from the tumor and adjacent brain. [ 4 27 28 32 ]…”

What is the ideal grade of resection for parasagittal meningiomas with the invasion of superior sagittal sinus? Simpson I or Simpson II resection? A retrospective observational study

“…is is a historic sample where surgery was performed by the neurosurgery team of the present author, P.H.P.A., between 2004 and 2010. [2] • Group B Group B consists of 30 cases of patients with PSMs and invasion of the SSS, subjected to Simpson II surgical resection, with preservation of the lateral wall, performed by the neurosurgery team of the present author, P.H.P.A., between 2015 and 2021.…”

“…e cut in the dura mater meninges is performed in the shape of the letter "C, " with the opening in the direction of the sagittal sinus. [2] During the entire procedure, the midline is not exceeded, and the boundary defined by the neuronavigator is respected to avoid impairment of the SSS. However, if the SSS is damaged, it is attempted to stem the bleeding using cotton wool and raising the bedhead.…”

“…In addition, when working on the removal of the PSM in the middle and posterior thirds, the vein of Trolard is under continuous observation, avoiding damaging, and sacrificing this vein through microresection. [2] With the brain exposed, it is possible to see the meningioma in the parasagittal region. e tumor resection operation is assisted by a view of the structures with an Opmi Pentero 800 microscope (Zeiss Medical Technology, USA).…”

“…e coagulation of the implant is then performed, and microsurgery is employed to remove the PSM. [2] Surgical resection of PSMs in Group A took place through the removal by SG I, in other words, with the total removal of the tumor, removal of the dura mater, any abnormal bone, and reconstruction of the SSS. [2] Surgical resection of PSMs in Group B took place through the removal by SG II, totally removing the tumor with the preservation of the lateral wall of the SSS.…”