Parasagittal Meningioma Surgery (original) (raw)
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Parasagittal meningiomas: surgical treatment outcomes
Ukrainian Neurosurgical Journal
Purpose: to improve the outcomes of surgical treatment of parasagittal meningioma patients by implementing a differentiated approach to the choice of surgical intervention, given the preoperative assessment of patency of the superior sagittal sinus (SSS) and collateral venous circulation. Materials and methods. Analysis of short-term and long-term outcomes of surgical treatment of 199 patients in the Department of Neurosurgery № 2, Mechnikov Dnipropetrovsk Regional Clinical Hospital was carried out. In the first follow-up period (2000 to 2012), the data were obtained retrospectively (95 cases). In the second follow-up period (2013 to 2021), the data were obtained prospectively (104 cases). The patients were assigned to the groups according to a differentiated approach (implemented in 2013) to the choice of surgical treatment tactics based on preoperative angiographic data (selective cerebral angiography and CT angiography). Results. In the first follow-up period, the completeness of...
Parasagittal meningiomas: follow-up review
Surgical neurology, 2006
Background: Parasagittal meningioma is one that fills the parasagittal angle, with no brain tissue between the tumor and the SSS. Invasion of the SSS is a challenge for complete removal and, consequently, for recurrence of these tumors. The objective of this study was to analyze the factors that influenced the clinical outcome of patients with parasagittal tumors surgically treated. Methods: Review of data on 53 patients with diagnosis of parasagittal meningiomas surgically treated from 1984 to 2004. Thirty-four (64.2%) were female and 19 (35.8%) were male; age ranged from 18 to 81 years old (mean, 54.98 F 5.80). Follow-up ranged from 2 to 261 months (mean, 93.71 F 68.45). The patients were operated on using microsurgical techniques. Tumors in the anterior third (9) or occluding the SSS (5) were removed with the sinus; tumors touching/pouching the SSS (20) were removed and its dural attachment coagulated; tumors invading one sinus wall were removed with partial excision and reconstruction of the sinus wall, and tumors invading more than one sinus wall in the posterior two thirds of the SSS (7) had a subtotal removal. No attempt at sinus resection and reconstruction was performed for tumors placed in the posterior two thirds of the SSS. Analysis of the patient outcome was done using survival and RFS Kaplan-Meier curves. The v 2 , Fisher exact, log-rank, Mann-Whitney, and Kruskall-Wallis ANOVA tests were used for comparing demographic data, survival curves, proportions, and medians, respectively. Results: Total and subtotal resection were achieved in 85% and 13.1%, respectively. Males had better survival than females ( P = .0252). Total RF rates were 10%, 25%, and 100% at 5 years and 100%, 50%, and 100% at 10 years for patients with meningiomas WHO grades I, II, and III, respectively. The RF survival curve was better for patients with grade I meningioma (grades I vs II vs III, P = .0001). There was no difference between the RF survival curves according to age, histopathologic WHO grade, location along or invasion of the SSS, and extent of resection. Males ( P = .0401), WHO grade I ( P b .0001), total resection ( P = .0139), and less sinus invasion ( P = .0308) had better RFS curves. Operative, surgery-related, and overall mortality were 1.9%, 5.4%, and 26.4%, respectively. Conclusions: Recurrence of parasagittal meningiomas predominated in males, in grades II/III tumors, after subtotal resection, and with more invasion of the SSS. Subtotal or total resections without sinus resection were considered adequate for treating these patients. D
Attempted Radical Removal of Parasagittal Meningioma: Risks and Benefits
Ain Shams Medical Journal, 2019
Background: Parasagittal meningiomas involving 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. Aim of the work: was to evaluate the risk/benefit ratio in attempting radical excision of parasagittal meningiomas involving the superior sagittal sinus. Patients and methods: The study consisted of 25 patients who had undergone surgery for parasagittal meningioma. Patients with meningioma involving the anterior third of the sinus underwent radical removal. Patients with meningioma that was involving the middle and posterior third of the sinus had a radical removal if the sinus was completely obliterated, and subtotal removal of tumors that are infiltrating but not obliterating the SSS. Results: 23 patients (92%) had radical tumor resection achieving Simpson GI and 2 patients (8%) had subtotal tumor resection achieving Simpson GIV. There were 3 postoperative transient neurological deterioration (12%) and 2 postoperative deaths (8%). The recurrence rate in the study was 5%, with a follow-up for 24 months. Conclusion: The benefits must be carefully weighed against the risks deciding between more aggressive, radical, or less aggressive subtotal resections. The less aggressive subtotal resections if the sinus ispartially occluded may be a reasonable choice.
Parasagittal meningiomas – literature review and a case report
Journal of Clinical and Investigative Surgery, 2017
Meningiomas are tumors that can develop anywhere along the neuraxis, but with increased concentration in some specific areas. Parasagittal meningiomas have the dural attachment on the external layer of the superior sagittal sinus (SSS) and invade the parasagittal angle displacing brain away from its normal position. Among meningiomas, the parasagittal location is the most common (22%). Taking into account their anatomic insertion along SSS, parasagittal meningiomas can have their dural attachment in the anterior, the middle or the posterior third of the SSS. Most frequently parasagittal meningiomas are located in the middle third of the superior sagittal sinus (between coronal suture and lambdoid suture). The clinical picture of parasagittal meningiomas depends on the tumor location along the SSS and so is the attitude towards ligation and reconstruction of the sinus. Controversial issues regarding surgical management of parasagittal meningiomas concerning leaving a tumor remnant that invades the SSS instead attempting total resection, or the attitude in the case of totally occluded segment of a sinus are summarized in this paper. The special care for the venous system is emphasized. The recurrence matter is also approached underlining the importance of adjuvant radiosurgery for the management of residual tumors. Results described in the main papers of the literature are reviewed. Conclusions are referring to the historical evolution regarding the surgical management of parasagittal meningiomas: aggressiveness of resection, sinus reconstruction, importance of adjuvant techniques: radiosurgery, endovascular surgery and to the importance of microsurgery and careful and meticulous planning of the approach in order to avoid interference with venous collaterals. A suggestive clinical case from the authors experience is presented. Acne conglobata is a rare, severe form of acne vulgaris characterized by the presence of comedones, papules, pustules, nodules and sometimes hematic or meliceric crusts, located on the face, trunk, neck, arms
Recurrence of surgically treated parasagittal meningiomas: a meta-analysis of risk factors
Acta Neurochirurgica, 2020
Background As the predictive role of many risk factors for parasagittal meningioma (PM) recurrence remains unclear, the objective of the meta-analysis was to make a comprehensive assessment of the predictive value of selected risk factors in these lesions. Methods Studies including data on selected risk factors, such as histology, tumor and sinus resection, sinus invasion, tumor localization, and immediate postoperative radiotherapy for PMs recurrence, were searched in the NCBI/NLM PubMed/ MEDLINE, EBM Reviews/Cochrane Central, ProQuest, and Scopus databases, and analyzed using random effects modeling. Results Thirteen observational studies involving 1243 patients met the criteria for inclusion in the meta-analysis. WHO grading of meningiomas was identified as the most powerful risk factor for recurrence. WHO grade II meningiomas (OR 11.61; 95% CI 4.43-30.43; P < .01; I 2 = 31%) or composite group of WHO grades II and III (OR 14.84; 95% CI 5.10-43.19; P < .01; I 2 = 48%) had a significantly higher risk of recurrence than benign lesions. Moreover, an advanced sinus involvement (types IV-VI according to the Sindou classification) (OR 3.49; 95% CI 1.30-9.33; P = .01; I 2 = 0%) and partial tumor resection (Simpson grades III-V) (OR 2.73; 95% CI 1.41-5.30; P = .03; I 2 = 52%) were associated with a significantly higher risk of recurrence than their counterparts. Conclusion Among the selected risk factors, high-grade WHO lesions, advanced sinus invasion, and partial tumor resection were associated with a higher risk of PM recurrence, with WHO grading system being the most powerful risk factor. Keywords Meta-analysis. Parasagittal meningioma. Recurrence. Risk factors This article is part of the Topical Collection on Tumor-Meningioma.
Prognostic Factors for Parasagital Meningiomas Recurrence
Ukrainian Scientific Medical Youth Journal
the study is relevant due to high prevalence of this type of pathology. Meningiomas account for 18% to 34% of all primary brain tumors. Parasagital meningiomas occur in 24.3% to 38.6% of cases. Despite their predominantly benign nature, parasagital meningiomas are more likely to recur/continue growing than meningiomas in other areas (18% to 40%). The key purpose of the study was to analyze the prognostic factors of parasagital meningiomas recurrence/continued growth, which will eventually improve surgical treatment outcomes. We conducted a retrospective and prospective analysis of 199 parasagital meningioma patients who were treated in Mechnikov Dnipropetrovsk Regional Clinical Hospital, Dnipropetrovsk Regional Council, from 2000 to 2021 inclusive. This article is based on a comparative analysis of the results of examination and surgical treatment and further analysis of pathohistological conclusion in two study groups. The first group included 180 (90.5%) patients with no recurren...
Microsurgical treatment for parasagittal meningioma in the central gyrus region
Oncology letters, 2013
The aim of the present study was to determine the efficacy of microsurgery treatment for parasagittal meningioma in the central gyrus region. A microsurgical technique was used to treat 26 patients with large parasagittal meningioma in the central gyrus region. The Rolandic and draining veins and the peritumoral normal brain tissue were retained, and the associated sagittal sinus was appropriately protected. A Simpson grade I, II or III resection was performed in 8 (30.8%), 12 (46.2%) and 6 (23.1%) patients, respectively, with no post-operative mortalities. Following treatment, 9 patients exhibited hemiparalysis. No tumor recurrence was found in 21 patients during the follow-up examination. The treatment protocol described in the current study included sufficient pre-operative imaging evaluations, a skilled microsurgical technique, improved protection of the Rolandic vein and treatment of the sagittal sinus, and was found to significantly increase the total tumor removal rate and de...
Ain Shams Medical Journal
Background: The classic-teaching craniotomy for the venoussparing approach to a parasagittal meningioma (PSM) crosses the midline. This crossing might endanger the superior sagittal sinus (SSS) and the venous lacunae. Accordingly, some consultants employ the technique of not crossing the midline with the craniotomy in the venoussparing approach for a unilateral PSM. Aim: This study aimed to assess the recurrence of parasagittal meningiomas after Simpson grade II excision through unilateral craniotomies not crossing the midline. Methods: The study retrospectively reviewed the medical records of patients who underwent surgical excision of a PSM at our university hospital from 2008 to 2016. The inclusion criteria were PSM that were Simpson Grade II excised through unilateral craniotomies without crossing the midline. We included 72 nonconsecutive cases. Results: The mean age of the included patients was 58.7 years. The mean follow-up period was 103.4 months. Thirty-one cases were followed for more than ten years. The performed craniotomies were uneventful. There was no reported incidence of any venous injuries. There was no operative mortality and no persistent neurologic deficit. The five-year recurrence rate was 4.1%. The ten-year recurrence rate among the thirty-one cases with long follow-ups was 16.1%. Conclusion: The recurrence rate of the parasagittal meningiomas excised through unilateral craniotomies not crossing the midline was comparable to that of other studies that performed craniotomies crossing the midline. The results indicated that it may be unnecessary to cross the midline with the craniotomy for the venous-sparing approach for a unilateral PSM.