[Direct surgical outcome of meningiomas obliterating the superior sagittal sinus]

Aggressive surgery for parasagittal meningiomas is considered when superior sagittal sinus is totally thrombosed by the tumour. However, there is potential risk of venous outflow injury resulting in an intracerebral haemorrhage. The aim of this study is to present surgical technique and early surgical outcome of patients with meningiomas obliterating the superior sagittal sinus.

Ten patients (4 men and 6 women, mean age 58), operated for sagittal meningiomas with radiologically proved superior sagittal sinus obliteration, were analysed retrospectively. In all cases, radical surgery with the resection of invaded sagittal sinus was performed. The size of tumours varied between 35 and 100 mm; the mean was 53 mm. Five of them required reoperation because of tumour recurrence due to a previous incomplete resection. In five cases, bifrontal craniotomy was made, in four biparietal and in one parieto-occipital. Preoperative status and direct postoperative outcome were compared using the Karnofsky scale.

Very good outcome was achieved in 6 cases--the clinical status remained unchanged. In two, the outcome was good (in the first patient hemiparesis increased and in the second there was worsening of cortical visual disturbances). In two cases with an unfavorable outcome, one patient suffered quadriparesis and mutism; the other experienced cerebral edema with hemorrhagic infarct and died despite decompressive surgery. Both these patients were totally dependent before surgery (Karnofsky < 40).

In the radical resection of a tumour with occluded sinus, direct postoperative outcome ranges from good to very good in a significant number of cases. In dependent patients having a large tumour, there is the risk of an unfavourable outcome after radical surgery. In such cases, partial resection and further radiotherapy should be considered.