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Is sagittal sinus resection in falcine meningiomas a factor of bad surgical outcome?
Paulo Henrique Pires de Aguiar1, Rogério Aires, Marcos Vinicius Calfatt Maldaun
1Department of Neurology - São Paulo Medical School, University of Sao Paulo, São Paulo; Division of Neurosurgery of Santa Paula Hospital, São Paulo; Division of Neurosurgery of Brigadeiro, Unic Brazilian Health System- (SUS-UBHS), São Paulo; Division of Neurosurgery of São Camilo Hospital, São Paulo; Department of Surgery, Catholic Pontific University, Curitiba, Brazil.
Objective:
Meningiomas arising purely from the falx below the longitudinal sinus represents a surgical challenge for the neurosurgeon. The authors discuss the new aspects of surgical details that may avoid complications and determine the prognosis.
Materials And Methods:
We retrospectively evaluated our surgical experience from June 2004 to January 2010. Seventy patients harboring falcine meningiomas were included and submitted for surgical resection. All historical records, office charts and images were reviewed in order to sample the most important data regarding epidemiology, clinical pictures, radiological findings and surgical results, as well as the main complications. The patients were divided into three main groups: anterior third 32 patients (Group A), middle third 15 patients (Group B), 23 patients in the posterior third of falx (Group C).
Results:
In Group A, total macroscopic resection was achieved in 31 out of 32 cases (96.87%). Twenty five patients had Rankin 0, five patients had Rankin 1-2, two patients had Rankin 6. In Group B (15 patients), 10 patients had gross resection and Rankin 0, four patients had Rankin 1-2 and one patient had Rankin 6. In Group C (23 patients), 20 patients were absolutely able, Rankin score 0, after six months postoperative period (83.3% had excellent results) and no mortality. Four cases had Rankin score 1 - 2 (16.6%). Ten cases (43.47%) had Simpson I resection and ten cases (43.47%) had Simpson II.
Conclusion:
Despite larger lesion volumes, Group A meningiomas had a better outcome due to the position they were in, the tumor and surrounding structures. The preoperative preparation and surgical planning can preserve sagittal sinus; but in some cases, this is not possible. Sagittal sinus resection, as proven by this paper, is still a factor of bad surgical outcome. In the middle and posterior third, resection of sagittal sinus is a factor of a bad outcome, due to cerebral infartion.
Insights
Surgical resection of falcine meningiomas presents challenges. Optimal surgical planning and preservation of the sagittal sinus are crucial for better outcomes, especially in anteriorly located tumors.
Area of Science:
- Neurosurgery
- Oncology
- Neuropathology
Background:
- Falcine meningiomas, tumors arising from the falx cerebri below the superior sagittal sinus, pose significant surgical challenges.
- Tumor location and proximity to critical structures like the sagittal sinus influence surgical approach and patient outcomes.
- Understanding surgical nuances is key to minimizing complications and improving prognosis for these challenging tumors.
Purpose of the Study:
- To evaluate surgical strategies for falcine meningiomas located below the longitudinal sinus.
- To identify factors influencing surgical outcomes and complications in patients with falcine meningiomas.
- To discuss new surgical details that may improve prognosis and avoid complications.
Main Methods:
- Retrospective review of 70 patients who underwent surgical resection for falcine meningiomas between June 2004 and January 2010.
- Patients were categorized into three groups based on tumor location: anterior third (Group A), middle third (Group B), and posterior third (Group C) of the falx.
- Data collected included epidemiology, clinical presentation, radiological findings, surgical results, and complications, with assessment using the Rankin scale and Simpson resection grading.
Main Results:
- Group A (anterior falcine meningiomas) showed a high rate of total macroscopic resection (96.87%) with excellent functional outcomes (Rankin 0-2).
- Group B (middle third) had 10 patients with gross resection and Rankin 0, while Group C (posterior third) achieved 83.3% excellent results (Rankin 0) with no mortality.
- Resection of the sagittal sinus was associated with poorer surgical outcomes, particularly in the middle and posterior thirds, leading to cerebral infarction.
Conclusions:
- Anteriorly located falcine meningiomas (Group A) generally have better outcomes due to favorable tumor location and surrounding structures.
- Preoperative planning is essential for preserving the sagittal sinus, as its resection significantly correlates with adverse surgical outcomes.
- Sagittal sinus resection is a critical factor leading to poor outcomes, especially in middle and posterior falcine meningiomas, due to the risk of cerebral infarction.
