Optimal surgical strategy for meningiomas involving the superior sagittal sinus: a systematic review

Involvement of the superior sagittal sinus (SSS) by meningiomas poses specific challenges, without an agreement about the degree of surgical aggressiveness when dealing with these lesions. In this systematic review and meta-analysis, we compare outcomes and complication rates, after different surgical strategies. Studies focused on meningiomas involving the SSS were collected from numerous online databases. Surgical outcome and complication data were abstracted. Comparisons were made considering complication and recurrence rates between an "aggressive" and a "non-aggressive" surgical attitude. A total of 26 studies, encompassing 1614 patients, were identified. Most of the tumors (53%) arose from the middle third of SSS and 75% of patients had a patent sinus at the time of surgery. A favorable outcome was achieved in 73% of patients treated with an "aggressive" surgical attitude compared to 78% of patients treated with a "non-aggressive" surgical attitude. Complication rates were similar between "aggressive" and "non-aggressive" attitudes, except for a higher rate of venous infarct (4% versus 2%, respectively) and worsening of preexisting motor deficits (34% versus 13%, respectively) in aggressively treated patients. Recurrence rates were not substantially different in the two groups after accounting for length of follow-up. Patients with incomplete resection (Simpson grades II-V) or with high histological grade (WHO grade III) had significantly higher recurrence rates. A complete resection achieves higher rates of tumor control, however, without nullifying the risk of recurrence. Moreover, "aggressive" tumor removal is associated with higher rates of venous complications and worsening of preexisting motor deficits.