Superior Sagittal Sinus Obstruction by Giant Meningiomas: Is Total Removal Feasible?

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• 作者：Xingchao Wang¹ ; ² ; Ruofei Wu¹ ; ² ; Peng Zhang¹ ; ² ; Chaocai Zhang¹ ; ² ; Guidong Song¹ ; ² ; Zhixian Gao¹ ; ² ; ^{zhixian_g@163.com" class="auth_mail" title="E-mail the corresponding author}
• 关键词：Giant Meningiomas ; Microsurgery ; Superior sagittal sinus
• 刊名：World Neurosurgery
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：94
• 期：Complete
• 页码：111-119
• 全文大小：4369 K

文摘

To present our experience with microsurgical technique for patients with giant meningiomas (maximum diameter ≥7 cm) that obstruct the superior sagittal sinus (SSS).

Methods

All patients who were preoperatively diagnosed (between 2010 and 2014) with giant meningiomas involving the SSS in Ward 10 at the Neurosurgery Department of Beijing Tiantan Hospital were enrolled in this study. Patient charts, imaging findings, and outcomes were examined.

Results

The study included 6 male and 4 female patients with a mean age of 46.8 ± 10.7 years. The tumor sizes varied from 7 to 12 cm (mean, 8.8 ± 2.0 cm). All patients underwent customized craniotomies, and aggressive surgery for resection of the invaded SSS was performed. Simpson grade I removals were achieved in all cases. No cases of perioperative mortality occurred. Three patients required cranioplasty as a result of a decompressive craniectomy that was performed during the primary surgery. Histologic examinations showed 1 malignant and 9 benign meningiomas. During the follow-up period (mean, 29.0 ± 9.7 months), recurrence/progression occurred in 1 patient, and 1 patient was lost to follow-up. The recent Karnofsky Performance Score was 80 ± 32.3 and was improved in 5 patients and stabilized in 3 patients. In addition, 7 patients lived independently.

Conclusions

The rigorous preservation of cortical veins, draining veins, and eloquent areas should be implemented during the resection of large tumors that obstruct the SSS. Suitable individualized approaches associated with full exposure and low cerebral perfusion pressure levels after surgery are critical for favorable results, and the reconstruction of the SSS may not be necessary.