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

Abstract

Background:The radical resection of parasagittal meningiomas without complications and recurrences is the goal of the neurosurgeon. Nowadays, different managements are proposed. This study describes our surgical technique during the lesional excision and the reconstruction of the superior sagittal sinus (SSS).Methods:The total removal (Simpson I and II) of parasagittal meningiomas (WHO grade I and II) was obtained in 75 patients from September 2000 to January 2010. The indocyanine green videoangiography was used before the dural opening and, when necessary, to identify and preserve the cortical veins. The surgery of the SSS was performed in accordance with Sindou's classification, and its reconstruction was achieved through the use of a patch of galea capitis.Results:We had no cases of recurrence and thrombotic occlusion of the SSS in 5 years after the reconstruction. No complications were observed in 65 patients, and no cases of mortality were reported. Neurological focal deficits were observed in 5 patients. A brain swelling and a venous infarction were observed in 1 patient. Only one case of thrombotic occlusion was observed. A cerebrospinal fluid leak was observed in 2 patients, and a systemic complication was found in 1 patient.Conclusion:Several factors contribute to the success of the parasagittal meningioma surgery. We consider the preservation of the cortical veins to be important, and, when possible, we recommend the reconstruction of the anterior third of the SSS. Our experience has led us to believe that until now surgery is a winning choice if practiced by expert hands.

Prognostic Factors for Parasagital Meningiomas Recurrence

“…However, the resulting prognostic factors of parasagital meningioma recurrence/continued growth in this study are consistent with the data from known literature sources (Behzadmehr et al, 2021, Balik et al, 2020, Cucu et al, 2020, Salah et al, 2019, Siempis et al, 2020. However, we found that recurrence-free 5-and 10-year survival in PM patients is as follows: 1) in case of total tumor removal (Simpson I), 96.0% and 85.5%, respectively; in case of non-radical removal (Simpson II-V), 88.9% (p<0.05) and 81.9% (p<0.05), respectively.…”

“…Sindou and J.E. Alvernia classification (types I-VI) (Ricci et al, 2017). The risk of parasagital meningioma recurrence was individually assessed in patients with types I-II, III-IV, and V-VI superior sagittal sinus damage according to M.P.…”

“…Neoplasm location in close proximity to the superior sagittal sinus and the involvement of the sinus and parasagital emissary veins in the pathological process complicate the task of radical (Simpson I), and still safe, surgical removal. (Salah et al, 2019, Cucu et al, 2020. In this regard, the neurosurgeon is faced with a choice: either to attempt a radical (Simpson I) parasagital meningioma resection at the cost of a high risk of severe irreversible intraoperative and postoperative complications or opt to more gentle surgery, maintaining/improving the patient's functional state but, at the same time, exposing the patient to a higher risk of meningioma recurrence/continued growth.…”