Hydrocephalus Following Giant Transosseous Vertex Meningioma Resection

Introduction Meningiomas are among the most common primary intracranial tumors. While well-described, there is limited information on the outcomes and consequences following treatment of giant-sized vertex-based meningiomas. These meningiomas have specific risks and potential complications due to their size, location, and involvement with extracalvarial soft tissue and dural sinuses. Herein, we present four giant-sized vertex transosseous meningioma cases with involvement and occlusion of the sagittal sinus, that postoperatively developed external hydrocephalus and ultimately required shunting. Methods A retrospective chart review identified patients with large vertex meningiomas that were: (1) large (>6 cm) with hemispheric (no skull base) location, (2) involvement of the superior sagittal sinus resulting in complete sinus occlusion, (3) involvement of dura resulting in a large duraplasty area, (4) transosseous involvement requiring a 5 cm or larger craniectomy for resection of invaded calvarial bone. Results Tumors were resected in all four cases, with all patients subsequently developing external hydrocephalus which required shunting within 2 weeks to 6 months postsurgery. Conclusion We believe this may be the first report of the development of hydrocephalus following surgical resection of these large lesions. Based on our observations, we propose that a combination of superior sagittal sinus occlusion and changes in brain elasticity and compliance affect the brain's CSF absorptive capacity, which ultimately lead to hydrocephalus development. We suggest that neurosurgeons be aware that postoperative hydrocephalus can quickly develop following treatment of giant-sized vertex-based meningiomas, and that correction of hydrocephalus with shunting can readily be achieved.

Superior vena cava syndrome causing chylothoraces in a preterm neonate: a case report and literature review

A preterm neonate developed catheter-related central venous and dural sinus thrombosis. Superior vena cava (SVC) obstruction caused significant bilateral chylothoraces and SVC thrombotic obstruction led to generalized anasarca and multiple organ failure. Six weeks after the diagnosis of SVC and sagittal sinus occlusion and chylothoraces, the infant expired. We report a rare case of a chylothoraces secondary to SVC obstruction, and superior sagittal sinus thrombosis in a preterm neonate, and review the literature.