Meningiomas infiltrating the superior sagittal sinus: surgical considerations of 328 cases

Abstract

The aim of the study was to discuss our management strategy and results of patients affected by meningiomas infiltrating the superior sagittal sinus. We describe 328 patients with meningiomas that were infiltrating the superior sagittal sinus. All the patients were surgically treated. Patients with meningioma involving the anterior segment of the sinus underwent total sinus resection. Patients with meningioma that was infiltrating the middle and posterior third of the sinus had a complete sinus removal if the dural sinus was completely obliterated by meningioma and incomplete removal if the sinus was not occluded. The tumour removal was grade I according to Simpson's grading system in 193 cases and grade II or III in the remainder. The superior longitudinal sinus was totally resected in 215 patients and marginally resected in 113. The tumour reappeared in 38 patients. The number of re-interventions did not affect clinical outcome. The extent of removal significantly influenced the regrowth or recurrence rate. Our results suggest that the risks of aggressive surgery, with sinus reconstruction, may be avoided, and conservative surgery for meningiomas that are infiltrating but not obliterating the superior sagittal sinus may be a reasonable choice.

Radiosurgery for parasagittal and parafalcine meningiomas

“…Sacrifice or complex reconstruction of the superior sagittal sinus is advocated by some neurosurgeons to increase the degree of resection. 2 However, sinus reconstruction does not always prevent large, catastrophic infarcts. 22 Raza et al 18 reported a 10% postoperative complication rate and an 11% recurrence rate following microsurgical resection of 61 parasagittal meningiomas.…”

Management of meningiomas involving the transverse or sigmoid sinus

“…Because of these risks, several authors consider the presence of sinus patency to be a contraindication to aggressive management. 5,35 Tomasello et al 49 described a technique for maximizing tumor resection with the primary goal of preserving venous sinus outflow, which they used in 67 patients. Preoperative angiography and MR venography were performed to delineate peritumoral venous drainage and sinus patency and for embolization, if feasible.…”

“…Caroli et al 5 described a management strategy in which meningiomas involving the superior sagittal sinus were completely resected if the sinus was completely obliterated by tumor and incompletely removed if the sinus was not occluded. Of 328 patients, 193 underwent complete resection.…”

“…33 Other recent retrospective series with a 10-year follow-up or less documented much lower rates of recurrence. 5,13,43 In a review of the literature on meningiomas involving the superior sagittal sinus, Tomasello et al 49 stratified study populations by treatment strategy from conservative to most radical: total resection in the setting of complete sinus obstruction or when the sinus was "only marginally involved"; resection of an intrasinus tumor requiring patching of the sinus but not venous reconstruction; and radical resection of a tumor with massive sinus involvement requiring bypass techniques to restore sinus outflow. These authors found that the recurrence rate was 6%-29% when a conservative strategy was adopted; 14%-19% when an intrasinus tumor was resected, requiring sinus repair but not reconstruction; and 4% when sinus outflow was restored after tumor resection.…”

Imaging Techniques in Brain Tumor

“…For meningioma supplied both by ECA and ICA, the ICA often supplies the peripheral of tumor, while the ECA for the centre, most of which come from the ECA branch such as the dura artery. It's very important in the preoperative preparation for a parasinus meningioma to make sure whether sinus was completely obliterated (Caroli et al, 2006). Completely occluded dural sinus means a considerable formation of collateral circulation.…”