Asterion meningiomas

Asterion meningiomas arise from the posterior petrous ridge at the junction of the transverse and sigmoid sinuses (sinodural angle). The authors retrospectively reviewed the charts of seven patients with asterion meningiomas who underwent a Simpson I tumor resection by either the petrosal or suboccipital approach. Patients presented with headaches, dizziness, ataxia, or seizures. Preoperative angiograms and intraoperative observations confirmed occlusion of the transverse and sigmoid sinuses by tumor, thrombus, or both in four of the patients. In all cases, tumor infiltrated the sinuses and the sinuses were ligated without adverse sequelae. Temporal bone invasion was seen in one patient who had the only tumor recurrence. Postoperatively, there were two transient CSF leaks. Asterion meningiomas can be completely resected with a low incidence of major morbidity. In this small series, a patent transverse/sigmoid sinus was resected in three patients without sequelae. We believe that in young patients with asterion meningiomas a nondominant transverse/sigmoid sinus should be resected if the torcula is patent. More research is needed to determine the safety of resecting a patent dominant transverse/sigmoid sinus.