How I do it: the surgical resection of a middle third parasagittal meningioma with venous preservation strategy

Wang, Hongyao; Yang, Zixiao; You, Hua; Song, Jianping

doi:10.1007/s00701-022-05129-6

Cited by 3 publications

(2 citation statements)

References 10 publications

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“…It has been reported that when the venous sinus is wholly occluded, there is often a compensatory intracranial collateral venous circulation. Therefore, the venous system does not need to be reconstructed when the venous sinus is removed [4][5][6][7][8]. However, in recent years, Sindou et al have shown that in paranasal meningiomas with complete venous sinus occlusion, patients with venous sinus reconstruction achieve a better prognosis [9,10].…”

Section: Is Reconstruction Required After Resection Of the Venous Sin...mentioning

confidence: 99%

Analysis of the efficacy of microdissection of paravebous sinus meningiomas invading large venous sinuses

Zhao

Xing

et al. 2022

Preprint

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Objective: The surgical management of paravebous sinus meningiomas that invade major venous sinuses remains controversial. The need for complete resection of all tumors and the need for venous sinus reconstruction after resection remains a point of debate. In this article, we attempt to illustrate the results of complete resection of the lesion (including the invading venous sinus portion) and the consequences of restoring or not restoring venous circulation in terms of tumor recurrence, mortality, and post-operative complications. Methods: The authors collected 68 patients with paravebous sinus meningiomas. 60 patients belonged to the parasagittal meningiomas: 23 were located in the anterior third, in close relationship with the anterior central vein, 30 in the middle third, in close relationship with the posterior central vein, and 7 in the posterior third. 3 remaining lesions were located in the sinus confluence area, and 5 in the transverse sinus. All patients underwent surgery. We use the following classifications depending on the degree of venous sinus involvement: type I, where the lesion was attached to the outer surface of the sinus wall; type II, where the tumor invaded the sinus wall but did not break through it; type III, where it invaded the ipsilateral wall; type IV, where it invaded the lateral wall and the roof of the sinus; type V: complete occlusion of the sinus without the involvement of the contralateral wall; and type VI: total occlusion of the sinus with the participation of the contralateral fence as well. For type I meningiomas, we treat them by stripping off the outer layer of the sinus wall. In cases of type II to VI invasion of venous sinuses, we employ two strategies: one is non-constitutional, i.e., we remove the tumor together with the affected venous sinuses but do not repair the venous sinuses. The other is reconstructive: after completely removing the tumor, suturing or repairing the venous sinuses. Results: Complete tumor resection was achieved in 97.1% (66/68) of cases, and sinus reconstruction was attempted in 38 of 45 cases (84.4%) with sinus wall and sinus cavity invasion. The recurrence rate of patients in this study group was 5.9%(4/68), with a follow-up period of 33 to 57 months. The recurrence rate was significantly higher in patients with incomplete resection than in patients with complete resection (P=0.0026, Fisher test). The overall mortality rate was 4.4%, and all cases were due to malignant brain swelling caused by the failure to perform venous reconstruction after resectioning the whole meningioma type VI. 7 patients had worsening symptoms of neurological deficits or complete loss of neurological function (10.3%), with a significantly higher incidence in patients without venous reconstruction than in the venous reconstruction group (P<0.0001, Fisher test). There was no statistically significant pre-operative and post-operative KPS score in patients with type I to V. Still, in patients with type VI (who did not receive venous reconstruction), the post-operative KPS score was significantly worse. Conclusion: The relatively low recurrence rate (5.9%) in this study suggests the importance of complete resection of the tumor (including the invasive venous sinus portion). Patients who did not undergo venous reconstruction exhibited significant clinical deterioration postoperatively compared with other subgroups, suggesting that venous sinus reconstruction is necessary.

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Section: Is Reconstruction Required After Resection Of the Venous Sin...mentioning

confidence: 99%

Analysis of the efficacy of microdissection of paravebous sinus meningiomas invading large venous sinuses

Zhao

Xing

et al. 2022

Preprint

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“…According to their relationship to the coronal and herringbone sutures, FMs can be classified into anterior, middle, and posterior third FMs [2]. Middle-third FMs are usually hidden deep under the eloquent cortex and abundant bridging veins, which represent the main hindrances to surgical access [3,4]. Generally, the shortest trajectory is preferable for the removal of meningiomas [5].…”

Section: Introductionmentioning

confidence: 99%

Endoscopic Ipsilateral Interhemispheric Approach for Middle-Third Falcine Meningioma: A Case Report and Literature Review

Zhang

Wang

et al. 2023

Brain Sciences

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Middle-third falcine meningiomas (FMs) are usually hidden deep under the eloquent cortex and abundant bridging veins, which represent the main hindrances to surgical access. The endoscopic approach has the advantages of wide visualization and free visual axis without areas of visual blindness, which allows for the resection of FMs with good visualization in a narrow space, especially in deep operations. Here, we report a case of a middle-third FM treated using the endoscopic ipsilateral interhemispheric approach. A 55-year-old female who had suffered a headache for 6 months without other remarkable symptoms was diagnosed with middle-third FM combined with imaging evaluation. According to the imaging performance and anatomical features, we scheduled the endoscopic ipsilateral interhemispheric approach to access and remove the tumor. Consequently, gross total tumor resection was achieved without surgery-related complications. After the surgery, the patient had an uneventful recovery and was discharged with no neurological deficit. During the 24-month follow-up, the patient’s condition remained favorable, with no tumor recurrence. In our opinion, the endoscopic ipsilateral interhemispheric approach is a feasible surgical strategy for FMs, which deserves further exploration as a treatment option.

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Middle third falcine meningiomas-surgical nuances for cortical venous preservation

Bansal,

Shah,

Bora

et al. 2024

Acta Neurochir

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How I do it: the surgical resection of a middle third parasagittal meningioma with venous preservation strategy

Cited by 3 publications

References 10 publications

Analysis of the efficacy of microdissection of paravebous sinus meningiomas invading large venous sinuses

Analysis of the efficacy of microdissection of paravebous sinus meningiomas invading large venous sinuses

Endoscopic Ipsilateral Interhemispheric Approach for Middle-Third Falcine Meningioma: A Case Report and Literature Review

Middle third falcine meningiomas-surgical nuances for cortical venous preservation

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