Management of meningiomas involving the transverse or sigmoid sinus

Mazur, Marcus D.; Cutler, Aaron; Couldwell, William T.; Taussky, Philipp

doi:10.3171/2013.8.focus13340

Cited by 27 publications

(18 citation statements)

References 52 publications

(83 reference statements)

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“…Several studies presenting the results of surgery for parasagittal meningioma with significant venous involvement or invasion of the sagittal sinus highlight the surgical challenge. 4,21 While some authors favor a more balanced approach, 13 others favor radical resection to avoid recurrence. Neurological outcome in these series is not presented in detail, but complication rates are higher than those in convexity meningiomas without venous involvement.…”

Section: Discussionmentioning

confidence: 99%

Predictors of postoperative motor function in rolandic meningiomas

Ottenhausen

Rumalla

Younus

et al. 2019

Journal of Neurosurgery

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OBJECTIVEResection of supratentorial meningiomas is generally considered a low-risk procedure, but tumors involving the rolandic cortex present a unique challenge. The rate of motor function deterioration associated with resecting such tumors is not well described in the literature. Thus, the authors sought to report the rates and predictors of postoperative motor deficit following the resection of rolandic meningiomas to assist with patient counseling and surgical decision-making.METHODSAn institution’s pathology database was screened for meningiomas removed between 2000 and 2017, and patients with neuroradiological evidence of rolandic involvement were identified. Parameters screened as potential predictors included patient age, sex, preoperative motor severity, tumor location, tumor origin (falx vs convexity), histological grade, FLAIR signal (T2-weighted MRI), venous involvement (T1-weighted MRI with contrast), intratumoral hemorrhage, embolization, and degree of resection (Simpson grade). Variables of interest included preoperative weakness and postoperative motor decline (novel or worsened permanent deficit). The SPSS univariate and bivariate analysis functions were used, and statistical significance was determined with alpha < 0.05.RESULTSIn 89 patients who had undergone resection of convexity (80.9%) or parasagittal (19.1%) rolandic meningiomas, a postoperative motor decline occurred in 24.7%. Of 53 patients (59.6%) with preoperative motor deficits, 60.3% improved, 13.2% were unchanged, and 26.4% worsened following surgery. Among the 36 patients without preoperative deficits, 22.2% developed new weakness. Predictors of preoperative motor deficit included tumor size (41.6 vs 33.2 cm3, p = 0.040) and presence of FLAIR signal (69.8% vs 50.0%, p = 0.046). Predictors of postoperative motor decline were preoperative motor deficit (47.2% vs 22.2%, p = 0.017), minor (compared with severe) preoperative weakness (25.6% vs 21.4%, p < 0.001), and preoperative embolization (54.5% vs 20.5%, p = 0.014). Factors that trended toward significance included parafalcine tumor origin (41.2% vs 20.8% convexity, p = 0.08), significant venous involvement (44.4% vs 23.5% none, p = 0.09), and Simpson grade II+ (34.2% vs 17.6% grade I, p = 0.07).CONCLUSIONSResection of rolandic area meningiomas carries a high rate of postoperative morbidity and deserves special preoperative planning. Large tumor size, peritumoral edema, preoperative embolization, parafalcine origin, and venous involvement may further increase the risk. Alternative surgical strategies, such as aggressive internal debulking, may prevent motor decline in a subset of high-risk patients.

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Section: Discussionmentioning

confidence: 99%

Predictors of postoperative motor function in rolandic meningiomas

Ottenhausen

Rumalla

Younus

et al. 2019

Journal of Neurosurgery

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“…In some of these, notably the venous sinuses and around the optic pathways, it has become common to attempt STR and consider radiation treatment after resection [10,[43][44][45]. However, the decision whether to treat these tumor remnants upfront, or to follow them and treat with radiation when the remnant increases, remains a controversial topic.…”

Section: Radiation Following Subtotal Resection Of Grade II Meningiomamentioning

confidence: 97%

Review of controversies in management of non-benign meningioma

Paldor

Awad

Sufaro

et al. 2016

Journal of Clinical Neuroscience

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“…Specimens from patients with hypertrophic pachymeningitis or meningioma can be obtained by standard meningeal biopsy or resection. 13,16,22 However, this procedure may cause relatively severe surgical trauma. Thrombus specimens from patients with cerebral venous sinus thrombosis can be obtained by mechanical thrombectomy.…”

Section: Discussionmentioning

confidence: 99%

Percutaneous endovascular biopsy in the diagnosis of venous sinus lesions: technical note

Tao¹,

Li²,

et al. 2019

Journal of Neurosurgery

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Intracranial hypertension (IH) may be misdiagnosed owing to the lack of typical imaging features and pathological confirmation of the sinus lesions. The authors report the use of percutaneous endovascular biopsy (PEB) for the diagnosis of IH in patients with venous sinus lesions. A total of 9 patients (age 46 ± 9 years) underwent PEB between June 2016 and August 2017. All patients underwent lumbar puncture and contrast-enhanced MRI before the procedure. PEB was technically successful in 6 patients. No intra- or postprocedural complications occurred. The confirmed lesions were meningioma in 2 patients and fibrous thrombus in 4 patients. All patients received individualized treatment. PEB of venous sinus lesions is a safe and efficient method to establish an early diagnosis and appropriate treatment in patients with IH.

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Management of meningiomas involving the transverse or sigmoid sinus

Cited by 27 publications

References 52 publications

Predictors of postoperative motor function in rolandic meningiomas

Predictors of postoperative motor function in rolandic meningiomas

Review of controversies in management of non-benign meningioma

Percutaneous endovascular biopsy in the diagnosis of venous sinus lesions: technical note

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