Surgical management of superior sagittal sinus in parasagittal meningiomas. Experience with 25 cases and review of literature

ABSTRACT

Twenty-five patients having parasagittal meningiomas were subjected to surgical intervention and tumor excision. The clinical picture varied according to the location, mass effect and vascular compromise of the tumor along the superior sagittal sinus [SSS]. Magnetic resonance imaging [MRI], MRI venography and computed tomography [CT] were the main tools of investigation. The location of the tumors was 56% in the middle third, 36% in the anterior third and 8% in the posterior third. The SSS was found to be totally occluded in 28%, partially occluded in 24% and patent in 48% of the cases. Postoperatively, the patients were followed up clinically and radiologically with an average follow up period of 22.3 months. The outcome was excellent in 16 patients, good in five patients, poor in two patients and two deaths occurred. The recurrence rate was 8%. It was concluded that the management of the SSS and the cerebral veins draining into it is the primary consideration in the removal of parasagittal meningiomas. The surgical technique depended mainly on the location of the tumor and the degree of SSS involvement. The microsurgical venous anastomosis of the cortical veins and the sinus in the middle and posterior third tumors with partially involved SSS must be considered