Outcomes of Excision of Parasagittal Meningiomas

Abstract

Background: Meningiomas that have any relation to the superior sagittal sinus are called parasagittal meningiomas. They have an insidious onset and grow gradually and can reach a large size without any manifestations. The surgical management of these tumors is still controversial whether to excise the tumor completely with risks of cerebral infarction and massive brain edema or to excise it gradually with lifting some tumor remains with the risk of tumor recurrence.
Objective: To report our experience with the surgically managed parasagittal meningiomas with analysis of factors that influence the patients’ outcome and reporting the complications including tumor recurrence.
Patient and method: A retrospective study was applied on 27 patients (17 females and 10 males) with parasagittal meningiomas in Sohag District between September 2015 and September 2018 with a mean age of 53.5 ± 2 years. Preoperative and postoperative data were collected and analyzed.
Results: Out of 27 patients, in 14 of them the sinus was patent, in 9 the sinus was partially occluded, and 4 patients had complete sinus occlusion. The sinus was ligated and excised with the tumor in 11 patients, of those eleven patients, four had venous infarction and three had postoperative massive brain edema. The second group included 16 patients at which, residuals of tumors were left behind with the sinus. Remote follow-up of this group show recurrence in 3 patients.
Conclusion: The outcome of radical resection is favorable whenever possible as the main limiting factor for achieving gross total resection is sinus involvement. However complete excision is crucial to prevent recurrence and many factors share in the success of the surgery. However, the sinus invaded meningiomas should be cautiously managed to prevent postoperative hemodynamic complications.