Major venous sinus resection in the surgical treatment of recurrent aggressive dural based tumors.
BACKGROUND
Despite gross total resection, aggressive dural based tumors invading major venous sinuses have high recurrence rates with poor long-term survivability. Options for aggressive surgical management of dural sinus invasion may be limited by the inherently high risk of morbidity and mortality.


METHODS
Between July 1996 and July 2002, 5 cases of recurrent aggressive dural based tumors were operated on. Gross total resection had been previously performed in 4 cases, and near total resection in 1 case. Tumor pathology included 2 malignant meningiomas, 1 hemangiopericytoma, 1 atypical meningioma, and 1 benign meningioma with atypical features. All tumors recurred within 3 to 47 months and occluded a major venous sinus (four superior sagittal and one dominant right transverse sinus). Gross total resection of tumor and involved venous sinus was accomplished in each case.


RESULTS
Three patients had no signs of clinical or radiographic recurrence at 10, 18, and 53 months of follow up. One patient who developed a fatal pulmonary embolism 10 months postoperatively had evidence of tumor progression on autopsy. One patient had tumor recurrence at 10 months, but is alive at 38 months and receiving adjunctive therapy.


CONCLUSIONS
For aggressive dural based tumors that recur with invasion of a major venous sinus, radical resection of tumor and occluded sinus can be performed safely and may improve long-term survival.
Buster
Ward P
WP
Division of Neurological Surgery, Central Illinois Neuroscience Foundation, Bloomington, IL 61701, USA.
Rodas
Raul A
RA
Fenstermaker
Robert A
RA
Kattner
Keith A
KA
D000328:Adult; D002533:Cerebral Angiography; D003251:Constriction, Pathologic; D003392:Cranial Sinuses / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D004388:Dura Mater / Q000473:pathology / Q000601:surgery*; D005260:Female; D006393:Hemangiopericytoma / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008577:Meningeal Neoplasms / Q000175:diagnosis / Q000601:surgery*; D008579:Meningioma / Q000175:diagnosis / Q000601:surgery*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D019635:Neurosurgical Procedures / Q000009:adverse effects; D016896:Treatment Outcome