gms | German Medical Science

Objective: Surgical management of parasagittal meningiomas (PM) may be challenging and the intraoperative strategy during resection may vary according to the degree of invasion and/or obliteration of the superior sagittal sinus (SSS). The objective of this study was to analyze the surgical strategy, operative results, peri- and postoperative course, rate of recurrence and neurological outcome of patients treated for PM.

Method: This is a retrospective single center analysis based on the data of 27 patients (22 female and 5 male, age 33-79 years), who were surgically treated between January 2007 and March 2013 for meningiomas in direct contact with the SSS. All data were obtained from the electronic records and analyzed using a SPSS database. Tumor volume was calculated from imaging according to the formula (a x b x c)/2. Neurological outcome was assessed postoperatively and during the most recent follow-up.

Results: Mean tumor volume was 44.4 ccm ranging from 0.7 ccm to 420 ccm. In 2 patients (7.4%) with tumors located along the first third of SSS, ligation of the sinus was performed during resection. In these cases sinus obliteration caused by the tumor was considered to be complete according to preoperative MRI. In all other patients, surgical resection was performed with preservation of the SSS Histological grading according to the WHO system was °I in 77,8% and °II 22,2% patients. Extent of resection was 33.3%, 33.3%, 29.6% and 3.7% according to Simpson grade I, II, III and IV, respectively. 1 patient showed a growing tumor remnant and underwent reoperation about 2 years after initial surgery followed by radiotherapy. 2 patients with small residual tumors underwent radiotherapy. The overall rate of recurrent or growing tumor remnants was 12,5% in 3 out of 24 patients with a mean observation period of 21.2 months (3-70 months). The overall surgical complication rate was 14.8% (n=4). In 2 patients a symptomatic intracranial bleeding occurred, 1 patient had a CSF fistula and another patient developed a meningitis. 22 patients (81.5%) were unchanged or improved immediately after surgery, while 5 patients (18.5%) had a new deficit postoperatively, which improved during follow-up.

Conclusions: A conservative surgical approach with preservation of the SSS in patients with PM resulted in an acceptable rate of recurrence in this small study population.