scholarly journals Resection of Giant Invasive Parasagittal Atypical Meningioma With a Venous Graft Reconstruction of the Sagittal Sinus: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Emad Aboud ◽  
Wardan Almir Tamer ◽  
Walid Ibn Essayed ◽  
Ossama Al-Mefty
Keyword(s):  
Saphenous Vein Graft ◽  
Venous Drainage ◽  
Radical Resection ◽  
Surgical Removal ◽  
Sagittal Sinus ◽  
Simpson Grade ◽  
Grade Ii ◽  
Graft Reconstruction ◽  
Venous Complication ◽  
Parasagittal Meningioma

Abstract Parasagittal meningioma becomes challenging when it involves the sagittal sinus and frequently invades the skull1; hence, resection of the invasive bone and management of the involved sinus are the two crucial issues in these tumors; notwithstanding the practice of conservative surgical resection coupled with irradiation (radiosurgery or stereotactic radiotherapy),2 radical surgical removal, including the invaded bone and sinus (Simpson grade I), alleviates recurrences. It is more valuable and particularly recommended in grade II meningiomas,3 since radical surgery is the principal factor in a long control of grade II meningioma4 and radiation effectiveness is directly related to gross total removal.5 On the other hand, removal of tumor involving the sinus and sinus reconstruction has been recommended and practiced for years.6-10 When the sinus is occluded, preservation of the collateral venous drainage becomes paramount.11 If the collateral venous drainage included cutaneous and dural channels, as in this patient, reconstructing of the sinus would become preventative of a major venous complication. Sindou et al8 even advocate the routine reconstruction of occluded sinus to minimize morbidity.  The patient is 39 yr old with a giant parasagittal meningioma that invaded the skull, occluded the sinus at the mid-third, and had venous collateral through the dura and cutaneous veins. He underwent radical resection with reconstruction of the sinus by saphenous vein graft. Patient consented for the operation and publication of images.  Illustrations at 1:51 and 2:15 from Al-Mefty O, Operative Atlas of Meningiomas, © LWW, 1997, with permission.

scholarly journals Malignant Subdural Hematoma Associated with High-Grade Meningioma

2018 ◽  
Vol 04 (02) ◽  
pp. e91-e95
Author(s):  
Shinichiro Teramoto ◽  
Akira Tsunoda ◽  
Kaito Kawamura ◽  
Natsuki Sugiyama ◽  
Rikizo Saito ◽  
...  
Keyword(s):  
Subdural Hematoma ◽  
Superior Sagittal Sinus ◽  
Chronic Subdural Hematoma ◽  
Acute Subdural Hematoma ◽  
Tumor Removal ◽  
Sagittal Sinus ◽  
Simpson Grade ◽  
Grade Ii ◽  
Bilateral Chronic Subdural Hematoma ◽  
Parasagittal Meningioma

AbstractA 70-year-old man, who had previously undergone surgical resection of left parasagittal meningioma involving the middle third of the superior sagittal sinus (SSS) two times, presented with recurrence of the tumor. We performed removal of the tumor combined with SSS resection as Simpson grade II. After tumor removal, since a left dominant bilateral chronic subdural hematoma (CSDH) appeared, it was treated by burr hole surgery. However, because the CSDH rapidly and repeatedly recurred and eventually changed to acute subdural hematoma, elimination of the hematoma with craniotomy was accomplished. The patient unfortunately died of worsening of general condition despite aggressive treatment. Histopathology of brain autopsy showed invasion of anaplastic meningioma cells spreading to the whole outer membrane of the subdural hematoma. Subdural hematoma is less commonly associated with meningioma. Our case indicates the possibility that subdural hematoma associated with meningioma is formed by a different mechanism from those reported previously.

Simpson Grade I Resection of Type II Clinoidal Meningiomal Through Cranio-orbital Zygomatic Approach: 2-Dimensional Operative Video

2021 ◽  
Author(s):  
Antonio Aversa ◽  
Ossama Al-Mefty
Keyword(s):  
Cavernous Sinus ◽  
Outer Wall ◽  
Radical Resection ◽  
Surgical Removal ◽  
Type Ii ◽  
Vascular Control ◽  
Mortality And Morbidity ◽  
Simpson Grade ◽  
Carotid Canal ◽  
Paraclinoid Aneurysms

Abstract Clinoidal meningiomas have been considered as a separate entity with distinguishing clinical, radiological, and surgical considerations.1–2 Surgical mortality and morbidity associated with anterior clinoidal meningiomas has remained high in the past, with radical resection considered unattainable.3 However, the extent of surgical removal is clearly the most determining factor in tumor recurrence and progression. Clinoidal meningiomas have been classified into 3 types according to their origin from the dura surface of the anterior clinoid and subsequent arachnoidal rearrangement around the parasellar neurovascular structures.1 In type II, there is an arachnoidal plane that allows the tumor dissection from the encased carotid artery and its branches and the optic nerve. In this type, the involvement of the cavernous sinus is limited to the external wall, which can also be removed. Hence, these tumors are amenable to Simpson grade I resection (tumor, dura, and bone). Approaching through the multidirectional axis provided by the cranio-orbital zygomatic approach allows safe exposure of the tumor and vascular control.4-5 Proximal carotid control is obtained in the petrous carotid canal, the invaded anterior clinoid is removed by and large extradurally, and the Sylvian fissure is split wide open to establish dissecting planes with the middle cerebral artery branches. The optic canal is opened, and tumor extension is removed.6 The invaded outer wall of the cavernous sinus and superior orbital fissure is removed. We demonstrate this technique in a 48-yr-old patient who consented for surgery and publication of images. All images at 2:27, center and right images at 2:46, and all images at 2:58, reused with permission from LWW, from Al-Mefty, Operative Atlas of Meningiomas. Left image at 2:46 reprinted from Surg Neurol, Vol 60/issue 6, Arnautović KI, Al-Mefty O, Angtuaco E, A combined microsurgical skull-base and endovascular approach to giant and large paraclinoid aneurysms, pp. 504–520, Copyright 1998, with permission from Elsevier. Image at 8:21 reprinted from Al-Mefty,1 Clinoidal meningiomas, by permission from JNSPG.

Total removal of a parasagittal meningioma of the posterior third of the sagittal sinus and its repair by autogenous vein graft

1979 ◽  
Vol 51 (3) ◽  
pp. 379-382 ◽  
Author(s):  
Akira Hakuba ◽  
Choon Woong Huh ◽  
Satoshi Tsujikawa ◽  
Shuro Nishimura
Keyword(s):  
Vein Graft ◽  
Saphenous Vein Graft ◽  
Lateral Wall ◽  
Clinical Results ◽  
Total Removal ◽  
Content Type ◽  
Sagittal Sinus ◽  
Sinus Wall ◽  
Autogenous Vein ◽  
Parasagittal Meningioma

✓ Total removal is reported of a parasagittal meningioma that invaded the lateral wall and lateral recess of the posterior third of the superior sagittal sinus. The operation was performed by using a silicone rubber non-collapsible tube with an inflatable balloon cuff at each end for the bypass of the sinus blood, and entailed repair of the defect in the sinus wall by a saphenous vein graft. The clinical results and angiographic findings are presented.

Meningiomas Invading the Superior Sagittal Sinus: Surgical Experience in 108 Cases

Neurosurgery ◽  
2004 ◽  
Vol 55 (6) ◽  
pp. 1263-1274 ◽  
Author(s):  
Francesco DiMeco ◽  
Khan W. Li ◽  
Cecilia Casali ◽  
Elisa Ciceri ◽  
Sergio Giombini ◽  
...  
Keyword(s):  
Superior Sagittal Sinus ◽  
Radical Resection ◽  
Complete Resection ◽  
Sagittal Sinus ◽  
Simpson Grade ◽  
Postoperative Hematoma ◽  
Lost To Follow Up ◽  
Age Range ◽  
Extreme Care

Abstract OBJECTIVE: Radical resection of meningiomas invading the superior sagittal sinus (SSS) presents several hazards. Some surgeons consider SSS invasion a contraindication for complete resection, and others advocate total resection with venous reconstruction. There is a lack of published large series to provide definitive guidelines for the surgical treatment of these complex cases. We report our 15-year experience with surgery of parasagittal meningiomas invading the SSS. METHODS: Between 1986 and 2001, 108 patients (73 women, 35 men; age range, 22–83 yr; mean age, 56.2 yr) underwent surgery at the Neurological Institute “C. Besta” of Milan for tumors invading the SSS. Parasagittal meningiomas not invading the SSS were excluded from this series. RESULTS: Simpson Grade I to II removal was achieved in 100 patients. Thirty patients with meningiomas totally occluding the SSS had complete resection of the encased portion of the sinus. Histological examination revealed 86 benign (79.6%), 16 atypical (14.8%), and 4 malignant (3.7%) meningiomas along with 2 hemangiopericytomas. There were two perioperative deaths. Serious complications included brain swelling (nine patients; 8.3%) and postoperative hematoma (two patients; 1.85%). Follow-up ranged from 19 to 223 months (mean, 79.5 mo). One patient was lost to follow-up. Tumors recurred in 15 patients (13.9%). After multivariate analysis, histological type, tumor size, and Simpson grade were confirmed as significant independent prognostic factors for recurrence. CONCLUSION: On the basis of our results, we conclude that if the sinus is partially invaded, it can be opened to obtain as complete a resection as possible and to attempt to preserve the patency of the sinus. If the sinus is obstructed, the portion of the sinus involved can be resected completely. In both situations, extreme care is vital to preservation of cortical veins, which may offer important collateral drainage. With our approach, good results are achieved and it is not necessary to reconstruct the sinus.

NCOG-30. AWAKE CRANIOTOMY FOR MENINGIOMA RESECTION: A STUDY ON THE SAFETY AND TOLERABILITY

2021 ◽  
Vol 23 (Supplement_6) ◽  
pp. vi158-vi158
Author(s):  
Saqib Kamran Bakhshi ◽  
Noyan Jawed ◽  
Faraz Shafiq ◽  
Syed Ather Enam
Keyword(s):  
General Anesthesia ◽  
Significant Risk ◽  
Intractable Pain ◽  
Early Recovery ◽  
Simpson Grade ◽  
Estimated Blood Loss ◽  
Duration Of Surgery ◽  
Grade Ii ◽  
The Mean ◽  
Parasagittal Meningioma

Abstract Resection of intra-axial brain tumors under scalp block improves safety of surgery, permitting preservation of neurological function and early recovery. However, limited data is available on employing this anesthesia technique for extra-axial tumors particularly meningioma, raising concerns that it may not be feasible due to dural attachment of tumor causing intractable pain and discomfort. We retrospectively analyzed 17 patients who underwent AC for resection of meningioma at our hospital during last 5 years, employing non-probability consecutive sampling. Variables for demographics, and details of diagnosis and surgical procedure were recorded. Eleven of these cases had grade I meningioma, and 6 had grade II meningioma. The mean age of these patients was 45.8 ± 10.5 years. Seizures were the most common presenting complain (n = 7; 41.2%). Eleven patients (58.3%) had convexity meningioma, 4 (33.3%) had parasagittal meningioma and 1 each had a parafalcine and anterior skull-base meningioma. The mean duration of surgery was 180.8 ± 36.2 minutes and the median estimated blood loss was 450 ml (IQR: 225 ml – 737.5 ml). The mean length of stay in the hospital was 3.1 ± 1.3 days. Only 1 patient had a prolonged hospital stay of 7 days because of post-operative seizures. Simpson grade I resection was performed in 6 (41.7%) patients, and grade II resection in 10 (50%) patients. Deterioration in pre-operative neurological exam was not seen in any patient, and no one required emergency intubation, conversion of surgery to general anesthesia, or re-operations. We propose that AC does not pose any significant risk of intra-operative or post-operative pain during meningioma resection, particularly convexity and parasagittal meningioma, and can make surgery possible for patients who are high risk for, or are not willing to undergo general anesthesia.

Venous preservation–guided resection: a changing paradigm in parasagittal meningioma surgery

2013 ◽  
Vol 119 (1) ◽  
pp. 74-81 ◽  
Author(s):  
Francesco Tomasello ◽  
Alfredo Conti ◽  
Salvatore Cardali ◽  
Filippo Flavio Angileri
Keyword(s):  
Recurrence Rate ◽  
Tumor Resection ◽  
Radical Resection ◽  
Tumor Control ◽  
Review Of The Literature ◽  
Venous Outflow ◽  
Sagittal Sinus ◽  
Aggressive Management ◽  
Parasagittal Meningioma

Object Surgical treatment of parasagittal meningiomas is challenging. Preserving the venous outflow is the key point, but this may preclude radical resection. Different surgical strategies have been proposed. To contribute to the debate on the optimal strategy for treating these tumors, a single-institutional, single-surgeon series of patients with parasagittal meningiomas was analyzed and the available literature reviewed. Methods Clinical charts of patients with parasagittal meningioma, managed at the University of Messina between 1988 and 2008, were retrospectively reviewed. A microsurgical resection, the goal of which was to preserve the venous outflow, was performed. Only if the superior sagittal sinus (SSS) was angiographically occluded, but if alternative venous outflow was clearly recognized, was the tumor resected, together with the sinus without further flow restoration. A MEDLINE review of the literature published between 1955 and 2011 was performed. Results Long-term follow-up (mean 80 months) data obtained in 67 patients with meningiomas involving the SSS were analyzed. The recurrence rate was 10.4%; the morbidity and mortality rates were 10.4% and 4.5%, respectively. The authors identified in the literature 19 relevant studies on this issue, and based on their review of the literature, there is no evidence that aggressive management offers an advantage in terms of recurrence rate. Conclusions Analysis of the data obtained in the 67 patients confirmed good outcome and long-term tumor control following a surgical strategy aimed to preserve venous outflow. These findings and the results of the authors' analysis of the literature emphasize that the goal of radical tumor resection should be balanced by an awareness of the increased surgical risk attendant on aggressive management of the SSS and bridging veins.

scholarly journals Dural Arteriovenous Fistula within Superior Sagittal Sinus Wall with Direct Cortical Venous Drainage: A Systematic Literature Review

2021 ◽  
Author(s):  
Rajendra Chavan ◽  
Shreya Sethi ◽  
Harsha Sahu ◽  
Neeraj Rao ◽  
Shivani Agarwal
Keyword(s):  
Literature Review ◽  
Treatment Option ◽  
Systematic Literature Review ◽  
Superior Sagittal Sinus ◽  
English Literature ◽  
Venous Drainage ◽  
Sagittal Sinus ◽  
Complete Obliteration ◽  
Cortical Venous Drainage ◽  
Special Subgroup

AbstractDural arteriovenous fistulas (DAVFs) located within superior sagittal sinus (SSS) wall with direct cortical venous drainage are rare. They are also known as variant DAVF (vDAVF) and form a special subgroup of DAVFs. Their chance of presenting with aggressive features is high compared with transverse sigmoid sinus fistula. They drain directly into cortical veins (Borden type 3, Cognard type III and IV). A systematic English literature review of SSS vDAVF was made. Systematic literature review revealed a total of 31 published cases. These were commonly seen in male population, (24 males, 77.41%, 24/31). Average age of patients was 54 years. A total of 24 patients (77.41%, 24/31) had aggressive clinical presentations with 13 patients (41.93%, 13/31) having intracranial hemorrhages (ICH). Two patients had rebleeding (15.38%, 2/13). Middle portion of SSS was commonly involved (15 cases, 75%). A total of 25 (96.15%, 25/26) cases had patent SSS. Most of the fistulas were idiopathic (65.38%, 17/26), with trauma being a frequent etiological factor (26.92%, 7/26). Venous ectasia was seen in 19 patients (59.37%, 19/32). Middle meningeal arterial (MMA) supply was seen in all patients (100%, 26/26), with bilateral MMA supply in 21 cases (80.76%), and unilateral in 5 cases (19.23%). Twenty patients (62.50%, 20/32) received only endovascular treatment (EVT), while four patients had EVT followed by surgery (12.5%, 4/32). Transarterial route via MMA was the preferred treatment option (79.16%). Complete obliteration of fistulas was noted in all cases (100%, 30/30). No immediate complication was noted after EVT. As much as 92.30% patients showed good recovery. Thus, SSS vDAVF forms a special subgroup of DAVF, with aggressive presentation, and warrants urgent treatment. EVT is effective treatment option and can produce complete obliteration.

Cordotomy for patients with thoracic malignant astrocytoma

2010 ◽  
Vol 13 (4) ◽  
pp. 418-423 ◽  
Author(s):  
Masaya Nakamura ◽  
Osahiko Tsuji ◽  
Kanehiro Fujiyoshi ◽  
Kota Watanabe ◽  
Takashi Tsuji ◽  
...  
Keyword(s):  
Tumor Resection ◽  
Radical Resection ◽  
Subtotal Resection ◽  
Optimal Management ◽  
Malignant Astrocytoma ◽  
Initial Operation ◽  
Who Grade ◽  
Kaplan Meier ◽  
Malignant Astrocytomas ◽  
Grade Ii

Object The optimal management of malignant astrocytomas remains controversial, and the prognosis of these lesions has been dismal regardless of the administered treatment. In this study the authors investigated the surgical outcomes of cordotomy in patients with thoracic malignant astrocytomas to determine the effectiveness of this procedure. Methods Cordotomy was performed in 5 patients with glioblastoma multiforme (GBM) and 2 with anaplastic astrocytoma (AA). A Kaplan-Meier survival analysis was performed, and the associations of the resection level with survival and postoperative complications were retrospectively examined. Results Cordotomy was performed in a single stage in 2 patients with GBM and in 2 stages in 3 patients with GBM and 2 patients with AA. In the 2 patients with GBM, cordotomy was performed 2 and 3 weeks after a partial tumor resection. In the 2 patients with AA, the initial treatment consisted of partial tumor resection and subtotal resection combined with radiotherapy, and rostral tumor growth and progressive paralysis necessitated cordotomy 2 and 28 months later. One patient with a secondary GBM underwent cordotomy; the GBM developed 1 year after subtotal resection and radiotherapy for a WHO Grade II astrocytoma. Four patients died 4, 5, 24, and 42 months after the initial operation due to CSF dissemination, and 3 patients (2 with GBM and 1 with AA) remain alive (16, 39, and 71 months). No metastasis to any other organs was noted. Conclusions One-stage cordotomy should be indicated for patients with thoracic GBM or AA presenting with complete paraplegia preoperatively. In patients with thoracic GBM, even if paralysis is incomplete, cordotomy should be performed before the tumor disseminates through the CSF. Radical resection should be attempted in patients with AA and incomplete paralysis. If the tumor persists, radiotherapy and chemotherapy are indicated, and cordotomy should be reserved for lesions growing progressively after such second-line treatments.

scholarly journals Study of Dural Arteriovenous Fistula Drains into Leptomeningeal Vein without Sinus Interposition

2004 ◽  
Vol 10 (1_suppl) ◽  
pp. 127-134 ◽  
Author(s):  
T. Kawaguchi ◽  
M. Nakatani ◽  
T. Kawano
Keyword(s):  
Emergency Treatment ◽  
Superior Sagittal Sinus ◽  
Venous Drainage ◽  
Craniocervical Junction ◽  
Sigmoid Sinus ◽  
Arteriovenous Fistulas ◽  
Sagittal Sinus ◽  
Dural Arteriovenous Fistulas ◽  
Cranial Fossa ◽  
Venous Ischemia

We evaluated dural arteriovenous fistulas (DAVF) drains into leptomeningeal vein (LMV) without the venous sinus interposition. This type of DAVF contained the extra-sinusal type DAVF and the DAVF with so-called pure leptomeningeal venous drainage (PLMVD). We studied 15 patients with DAVF that flows into LMVD without passing into the sinus. The subjects were 5 patients with DAVF in the anterior cranial fossa, 2 with DAVF in the tentorium cerebelli, and 3 with DAVF in the craniocervical junction as extra-sinusal type DAVF and 3 with DAVF in the transverse sigmoid sinus and 2 with DAVF in the superior sagittal sinus as DAVF with PLMVD. This type appears to take a very aggressive course. The arterial pressure of the shunt is directly applied to LMV, which causes bending and winding of the vein, eventually varices, inducing intracranial haemorrhage or venous ischemia in the LMV reflux area. Emergency treatment should be performed as soon as possible. Although it is recognized that interruption of the draining vein is very effective, treatment methods such as TAE, direct surgery, and g knife treatment, or their combinations should be carefully chosen for each case.

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