Complications after resection of parasagittal and superior sagittal sinus meningiomas

Parasagittal meningiomas (PSM) represent one of the most frequently encountered intracranial meningiomas and pose unique challenges given their intimate relationship with parasagittal bridging veins and superior sagittal sinus (SSS). Compromise of venous drainage during resection might be a source of significant postoperative complications including catastrophic intraparenchymal hemorrhage. Objective of this study was to identify postoperative complications and associated factors predisposing to their development. A retrospective review of histologically confirmed parasagittal meningiomas (Sindou grade 1-6) resected between 2011 and 2020 was performed. A total of 62 patients (35 females (56.45%); mean age 55.72) years were included. The mean follow-up was 40.84 months. Forty-two patients (67.74%) were treatment naïve. Complete SSS occlusion was noted in 23 (37.1%). WHO grade 1 tumor was diagnosed in 32 (51.61%), WHO 2 in 23 (37.1%) and WHO 3 in 7 cases (11.29%). The SSS was resected in 24 (38.71%) patients. Intraparenchymal hemorrhage (ICH) was noted after 8 (12.90%) surgeries. Prior surgery (p = 0.006, OR = 22.1; 95% CI = 2.48-196.5) and higher tumor grade (OR = 4.64, 95% CI = 1.45-14.79, p = 0.01) were independently associated with greater risk of ICH. Resection of the SSS was not associated with postoperative ICH (p = 0.1388). A procedure-related mortality was noted in 2 patients (3.2%). Long term postoperative headaches were reported in 14 (22.58%) patients, associated with the resection of the SSS (p = 0.0003). Four (6.56%) patients had a CSF diversion procedure noted at the last follow up, correlated with ICH (p = 0.0124). History of prior surgery and higher WHO grade seem to be correlated with a significantly elevated risk of hemorrhage. Increased intracranial pressure, requiring CSF diversion is relatively infrequent occurring only in 6% patients, however awareness is important as prevention of its sequela is straightforward, preventing debilitating morbidity.