Meningiomas invading the sagittal or transverse sinuses, resection with venous reconstruction.
Surgery of meningiomas involving dural sinuses leaves the surgeon confronted with a dilemma: leave the fragment invading the sinus and have a higher risk of recurrence, or attempt a total removal with or without venous reconstruction and expose the patient to a potentially greater operative danger. The authors report a series of 80 meningiomas (72 of the sagittal sinus, 5 of the transverse sinus and 3 of the torcular) in whom gross total removal was achieved in all but 7 cases (i.e., 91%), and venous reconstruction attempted in a majority. In total, 70 patients (87.5%) had a good outcome and resumed their previous activities. There was a permanent neurological deficit in seven (8.7%) due to infarction secondary to injury of central veins (all but one in the sagittal sinus mid-third). Three patients (3.6%) died from brain swelling; all with meningioma totally occluding the sinus and in whom resection was achieved without sinus reconstruction. There were two recurrences (2.5%) in this series which has a mean follow-up of 8.5 years. The conclusion is to favour, whenever possible, total removal with sinus reconstruction, using a patch for meningiomas with partial sinus invasion and a venous bypass for those with total sinus occlusion.
Sindou
M
M
Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, Lyon, France.
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002550:Cerebral Veins / Q000601:surgery; D003392:Cranial Sinuses / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D003399:Craniotomy / Q000379:methods*; D004388:Dura Mater / Q000601:surgery*; D004564:Electrocoagulation; D005260:Female; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008579:Meningioma / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D011859:Radiography; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures