title: Perioperative and long-term outcomes from the management of parasagittal meningiomas invading the superior sagittal sinus.
abstract: BACKGROUND
  Parasagittal meningiomas invading the superior sagittal sinus (SSS) pose formidable obstacles to surgical management. Invasion is often considered a contraindication to surgery because of associated morbidity, such as cerebral venous thrombosis.
  
  
  OBJECTIVE
  We report our most recent experience with the resection of parasagittal meningiomas invading the SSS.
  
  
  METHODS
  Between 1992 and 2004, 110 patients with parasagittal meningiomas underwent surgery at the Johns Hopkins Medical Institutions. Clinical charts, radiological studies, pathological features, and operative notes were retrospectively analyzed; only those patients with minimum 24 months follow-up (n = 61) were further studied.
  
  
  RESULTS
  Tumor distribution by location along the SSS was: 21% anterior, 62% middle, and 17% posterior. All patients were managed with initial surgical resection with radiosurgery for residual/recurrent disease if indicated (19.6%). Pathological examination revealed 80% grade I meningiomas, 13% grade II meningiomas, and 7% grade III meningiomas. Simpson grade I/II resection was achieved in 81% of patients. Major complications included venous thrombosis/infarction (7%), intraoperative air embolism (1.5%), and death (1.5%); long-term outcomes assessed included recurrence (11%) and improvement in Karnofsky Performance Score (85%).
  
  
  CONCLUSIONS
  On the basis of our study, the incidence of postoperative venous sinus thrombosis is 7% in the setting of a recurrence rate of 11% with a mean follow-up of 41 months. In comparison with the published literature, the data corroborate the rationale for our treatment paradigm; lesions invading the sinus can initially be resected to the greatest extent possible without excessive manipulation of vascular structures, whereas residual/recurrent disease can be observed and managed with radiosurgery.
authors.affiliation: Division of Neurosurgical Oncology, Department of Neurosurgery, The Johns Hopkins Hospital, Baltimore, Maryland, USA.
authors.forename: Shaan M
authors.initials: SM
authors.lastname: Raza
authors.forename: Gary L
authors.initials: GL
authors.lastname: Gallia
authors.forename: Henry
authors.initials: H
authors.lastname: Brem
authors.forename: Jon D
authors.initials: JD
authors.lastname: Weingart
authors.forename: Donlin M
authors.initials: DM
authors.lastname: Long
authors.forename: Alessandro
authors.initials: A
authors.lastname: Olivi
mesh_terms: D000368:Aged; D002533:Cerebral Angiography / Q000379:methods; D015331:Cohort Studies; D003392:Cranial Sinuses / Q000473:pathology* / Q000601:surgery*; D003399:Craniotomy / Q000379:methods*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008577:Meningeal Neoplasms / Q000601:surgery*; D008579:Meningioma / Q000601:surgery*; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods