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.
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.
Authors: Jaishri O Blakeley; D Gareth Evans; John Adler; Derald Brackmann; Ruihong Chen; Rosalie E Ferner; C Oliver Hanemann; Gordon Harris; Susan M Huson; Abraham Jacob; Michel Kalamarides; Matthias A Karajannis; Bruce R Korf; Victor-Felix Mautner; Andrea I McClatchey; Harry Miao; Scott R Plotkin; William Slattery; Anat O Stemmer-Rachamimov; D Bradley Welling; Patrick Y Wen; Brigitte Widemann; Kim Hunter-Schaedle; Marco Giovannini Journal: Am J Med Genet A Date: 2011-12-02 Impact factor: 2.802
Authors: Raymond Y Huang; Wenya Linda Bi; Brent Griffith; Timothy J Kaufmann; Christian la Fougère; Nils Ole Schmidt; Jöerg C Tonn; Michael A Vogelbaum; Patrick Y Wen; Kenneth Aldape; Farshad Nassiri; Gelareh Zadeh; Ian F Dunn Journal: Neuro Oncol Date: 2019-01-14 Impact factor: 12.300