Resident University of South Florida Tampa, Florida, United States
Introduction: Resection of parasagittal meningiomas involving the superior sagittal sinus (SSS) poses a dilemma, balancing extent of resection with possible devastating complications from venous hypertension from SSS occlusion. Although surgical paradigm has shifted towards a more conservative approach, instances of high grade tumors, recurrent tumors, or failed adjuvant therapy may force neurosurgeons to perform radical surgery involving SSS sacrifice. We sought to analyze risks of surgery for parasagittal SSS-involving meningiomas, some with sacrifice of the SSS.
Methods: We conducted a retrospective, analysis of all patients undergoing resection of parasagittal meningiomas involving the SSS from 2012-2020 at a tertiary care center. Sinus involvement was defined as tumor originating from the SSS wall or the convexity with SSS attachment. Pre- and postoperative SSS patency, postoperative signs of intracranial hypertension, degree of resection, and rates of recurrence were recorded.
Results: Thirty-two patients were included (mean age 58 years, 16 females). Preoperative SSS occlusion was identified in 13 (41%), stenosis in 10 (31%) and neither in 9 (28%) patients. Pathology was confirmed as WHO grade I in 19, II in 12 and III in one patient. Simpson grade I resection was achieved in 6, grade II in 15 and grade III in one patient. SSS resection was performed in 9/13 (64%) patients with complete SSS occlusion. Three intraparenchymal hemorrhages occurred during follow-up (9%, p=0.04). All hemorrhages occurred in WHO Grade II meningiomas, two after SSS preservation and one after SSS sacrifice. Two patients (both with preserved SSS) required permanent CSF diversion for increased intracranial pressure postoperatively. Three (23%) patients with presumed complete resection including the SSS remained tumor free during follow-up.
Conclusion : Resection of parasagittal meningiomas involving the SSS is associated with complications of impaired venous drainage regardless of preservation of the SSS, likely being dictated by other, yet to be identified, factors.
