Venous Compromise/Deep Venous Thrombosis During Parasagittal Meningiomas Resection

Abstract

We are reporting the case of JB, a 28-year-old male who presented to our hospital in 2009. The patient reported a progressive increase in a known mass that had been deforming their head since 2005. He had suffered from a first-time seizure four years later (in 2009). Neurological examination revealed a large tumor protruding in the parietal region, which was confirmed by CT. A subsequent MRI demonstrated a hyperostotic contrast-enhancing parasagittal tumor occluding the middle third of the superior sagittal sinus, with cortical veins joining the sinus adjacent to the tumor.The patient was taken to the OR for a craniotomy and a resection of the tumor with cranioplasty in the same setting. The tumor was exposed by using a straight incision on the scalp. A craniotomy was performed around the tumor by using multiple burr holes; now the bone could be separated from the dura and removed. The intradural tumor was exposed, and a cortical vein draining into the tumor could not be preserved. Some residual tumor was left close to the anterior part of the superior sagittal sinus. The dura was reconstructed with pericranium, and the bony defect was closed with titanium mesh. The patient woke up initially paraplegic, but 7 days later, he started with proximal movements in both legs. Unfortunately, he died suddenly in the second postoperative week, due to pulmonary embolism. The case is reviewed in this manuscript to analyze the contributing factors of the complications that were observed and to suggest management strategies to avoid them.