title: Venous preservation-guided resection: a changing paradigm in parasagittal meningioma surgery.
abstract: OBJECTIVE
  Surgical treatment of parasagittal meningiomas is challenging. Preserving the venous outflow is the key point, but this may preclude radical resection. Different surgical strategies have been proposed. To contribute to the debate on the optimal strategy for treating these tumors, a single-institutional, single-surgeon series of patients with parasagittal meningiomas was analyzed and the available literature reviewed.
  
  
  METHODS
  Clinical charts of patients with parasagittal meningioma, managed at the University of Messina between 1988 and 2008, were retrospectively reviewed. A microsurgical resection, the goal of which was to preserve the venous outflow, was performed. Only if the superior sagittal sinus (SSS) was angiographically occluded, but if alternative venous outflow was clearly recognized, was the tumor resected, together with the sinus without further flow restoration. A MEDLINE review of the literature published between 1955 and 2011 was performed.
  
  
  RESULTS
  Long-term follow-up (mean 80 months) data obtained in 67 patients with meningiomas involving the SSS were analyzed. The recurrence rate was 10.4%; the morbidity and mortality rates were 10.4% and 4.5%, respectively. The authors identified in the literature 19 relevant studies on this issue, and based on their review of the literature, there is no evidence that aggressive management offers an advantage in terms of recurrence rate.
  
  
  CONCLUSIONS
  Analysis of the data obtained in the 67 patients confirmed good outcome and long-term tumor control following a surgical strategy aimed to preserve venous outflow. These findings and the results of the authors' analysis of the literature emphasize that the goal of radical tumor resection should be balanced by an awareness of the increased surgical risk attendant on aggressive management of the SSS and bridging veins.
authors: Department of Neurosurgery, University of Messina, Italy.
authors: Francesco
authors: F
authors: Tomasello
authors: Alfredo
authors: A
authors: Conti
authors: Salvatore
authors: S
authors: Cardali
authors: Filippo Flavio
authors: FF
authors: Angileri
mesh_terms: D000328:Adult; D000368:Aged; D002533:Cerebral Angiography; D002550:Cerebral Veins / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008577:Meningeal Neoplasms / Q000401:mortality / Q000601:surgery*; D008579:Meningioma / Q000401:mortality / Q000601:surgery*; D008875:Middle Aged; D009017:Morbidity; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000601:surgery; D018365:Neoplasm, Residual / Q000401:mortality / Q000601:surgery; D010690:Phlebography; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors; D054063:Superior Sagittal Sinus / Q000601:surgery*