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Updated: May 14, 2026

Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas

Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas

Published on: January 17, 2018

Meningiomas engaging major venous sinuses.

Tiit Mathiesen¹, Jenny Pettersson-Segerlind¹, Lars Kihlström¹

¹Department of Neurosurgery, Karolinska Hospital, Stockholm, Sweden.

World Neurosurgery

|February 5, 2013

Summary

Venous meningiomas pose surgical challenges. Combining microsurgery with gamma-knife radiosurgery improves outcomes for these challenging brain tumors, especially when radical resection is not feasible.

Keywords:

Gamma-knife radiosurgery Parasagittal meningioma Proliferation index Surgical management Venous sinus

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Published on: January 17, 2018

Microvascular Decompression: Salient Surgical Principles and Technical Nuances

Microvascular Decompression: Salient Surgical Principles and Technical Nuances

Published on: July 5, 2011

Area of Science:

Neurosurgery
Oncology
Radiation Oncology

Background:

Venous meningiomas, tumors involving major venous sinuses, present significant surgical management challenges.
Radical surgical removal is often precluded by venous structure involvement, increasing recurrence risk and potential for aggressive histology.
Historical approaches involved a trade-off between radical surgery and subtotal removal with surveillance.

Purpose of the Study:

To review outcomes of venous meningiomas treated with contemporary surgical techniques and gamma-knife radiosurgery.
To evaluate the long-term efficacy and recurrence rates of different treatment strategies over a 10-year follow-up period.
To assess the prognostic relevance of tumor proliferation markers in venous meningiomas.

Main Methods:

Prospective collection of treatment, histopathology, and follow-up data for 100 consecutive patients with venous meningiomas.
Gamma-knife radiosurgery utilized as a direct postsurgical adjunct or after radiological follow-up.
Analysis of the proliferation marker MIB-1 (Ki-67) and 10-year follow-up for 98 patients.

Main Results:

Tumor recurrence or progression occurred in 23% of patients within 10 years.
Simpson grade 1 resection had a 10% recurrence rate, while Simpson grade IV had a 72% recurrence rate.
Combined Simpson IV microsurgery and gamma-knife radiosurgery reduced recurrence to 10%; MIB-1 indices predicted recurrence.

Conclusions:

Achieving radical surgical resection for venous meningiomas proved difficult.
Gamma-knife radiosurgery is a valuable adjunct, particularly for tumors with low proliferative indices, and may be best integrated into initial management.
Despite improvements, recurrence and malignancy remain significant challenges in managing venous meningiomas.