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Neurosurgery. 2010 Oct;67(4):885-93; discussion 893. doi: 10.1227/NEU.0b013e3181ef2a18.

Perioperative and long-term outcomes from the management of parasagittal meningiomas invading the superior sagittal sinus.

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  • 1Division of Neurosurgical Oncology, Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, Maryland, USA.

Abstract

BACKGROUND:

Parasagittal meningiomas invading the superior sagittal sinus (SSS) pose formidable obstacles to surgical management. Invasion is often considered a contraindication to surgery because of associated morbidity, such as cerebral venous thrombosis.

OBJECTIVE:

We report our most recent experience with the resection of parasagittal meningiomas invading the SSS.

METHODS:

Between 1992 and 2004, 110 patients with parasagittal meningiomas underwent surgery at the Johns Hopkins Medical Institutions. Clinical charts, radiological studies, pathological features, and operative notes were retrospectively analyzed; only those patients with minimum 24 months follow-up (n = 61) were further studied.

RESULTS:

Tumor distribution by location along the SSS was: 21% anterior, 62% middle, and 17% posterior. All patients were managed with initial surgical resection with radiosurgery for residual/recurrent disease if indicated (19.6%). Pathological examination revealed 80% grade I meningiomas, 13% grade II meningiomas, and 7% grade III meningiomas. Simpson grade I/II resection was achieved in 81% of patients. Major complications included venous thrombosis/infarction (7%), intraoperative air embolism (1.5%), and death (1.5%); long-term outcomes assessed included recurrence (11%) and improvement in Karnofsky Performance Score (85%).

CONCLUSION:

On the basis of our study, the incidence of postoperative venous sinus thrombosis is 7% in the setting of a recurrence rate of 11% with a mean follow-up of 41 months. In comparison with the published literature, the data corroborate the rationale for our treatment paradigm; lesions invading the sinus can initially be resected to the greatest extent possible without excessive manipulation of vascular structures, whereas residual/recurrent disease can be observed and managed with radiosurgery.

PMID:
20802356
DOI:
10.1227/NEU.0b013e3181ef2a18
[PubMed - indexed for MEDLINE]
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