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Updated: May 5, 2026
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Management of meningiomas involving the transverse or sigmoid sinus
Marcus D Mazur1, Aaron Cutler, William T Couldwell
1Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah.
Abstract:
Meningiomas that invade the transverse or sigmoid sinuses are uncommon tumors that are challenging to treat surgically. Although the risk of recurrence is associated with the extent of resection, complete removal of meningiomas in these locations must be balanced with avoidance of venous outflow obstruction, which could cause venous infarction and significant neurological consequences. When a meningioma occludes a venous sinus completely, gross-total resection of the intravascular portion is commonly performed. When the tumor invades but does not completely obliterate a major venous sinus, however, opinions differ on whether to accept a subtotal resection or to open the sinus, perform a complete resection, and reconstruct the venous outflow tract. In this paper, the authors review the different strategies used to treat these lesions and provide illustrative case examples.
Insights
Surgical removal of meningiomas invading transverse or sigmoid sinuses requires balancing complete tumor resection with avoiding venous outflow obstruction. Strategies vary for tumors partially or fully occluding these critical venous sinuses.
Area of Science:
- Neurosurgery
- Oncology
- Vascular Surgery
Background:
- Meningiomas invading transverse or sigmoid sinuses present unique surgical challenges.
- Complete resection is desired to minimize recurrence but must be weighed against risks of venous outflow obstruction.
Observation:
- Tumors completely occluding a sinus often undergo gross-total resection of the intravascular portion.
- For tumors partially invading a sinus, surgical strategies differ regarding subtotal resection versus sinus opening and reconstruction.
Findings:
- The optimal surgical approach for meningiomas invading major venous sinuses remains debated.
- Balancing oncological goals with the prevention of venous infarction is crucial.
Implications:
- Understanding different surgical strategies is vital for managing these complex tumors.
- Further research may refine optimal treatment protocols for sinus-invasive meningiomas.
- Patient outcomes depend on careful consideration of surgical risks and benefits.
