title: Efficacy of gamma-knife surgery for treating meningiomas that involve the superior sagittal sinus.
abstract: BACKGROUND
  Meningiomas involving the superior sagittal sinus (SSS) are among the most challenging tumors to treat. Authors of some recent series have advocated total removal with SSS reconstruction. However gamma-knife surgery is a reasonable choice for these tumors.
  
  
  METHODS
  This study focused on 43 cases of meningioma invading the SSS that were treated with gamma-knife therapy. Twenty-eight patients had undergone previous resection. The follow-up period after radiosurgery ranged from 24 to 86 months (median, 46 months). The median marginal dose was 15 Gy.
  
  
  RESULTS
  During follow-up, 22 (51%) tumors decreased in size, 16 (37%) remained unchanged, and 5 (12%) expanded. The overall rate of tumor control with radiosurgery was 89%.
  
  
  CONCLUSIONS
  When a small meningioma involves the SSS and the sinus is patent, the first-line treatment should be radiosurgery. If the tumor is large and the sinus is patent, we recommend gross total resection with no removal of SSS. If postoperative or follow-up MR imaging demonstrates residual tumor or recurrence, gamma-knife surgery should be performed. If a large meningioma has completely obliterated the SSS, our policy is to remove the tumor and all sinus tissue without reconstructing the SSS.
authors.affiliation: Department of Neurosurgery, Marmara University School of Medicine, Altunizade, Istanbul, Turkey.
authors.forename: M N
authors.initials: MN
authors.lastname: Pamir
authors.forename: S
authors.initials: S
authors.lastname: Peker
authors.forename: T
authors.initials: T
authors.lastname: Kilic
authors.forename: M
authors.initials: M
authors.lastname: Sengoz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D017023:Coronary Angiography; D003392:Cranial Sinuses / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008579:Meningioma / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D019635:Neurosurgical Procedures; D016634:Radiosurgery