Background: Parasagittal meningiomas involving the superior sagittal sinus (SSS) pose formidable obstacles to surgical
management. Invasion is often considered a contraindication to surgery because of associated morbidity, such as cerebral venous thrombosis. Aim of the work: was to evaluate the risk/benefit ratio in attempting radical excision of parasagittal meningiomas involving the superior sagittal sinus. Patients and methods: The study consisted of 25 patients who had undergone surgery for parasagittal meningioma. Patients with meningioma involving the anterior third of the sinus underwent radical removal. Patients with meningioma that was involving the middle and posterior third of the sinus had a radical removal if the sinus was completely obliterated, and subtotal removal of tumors that are infiltrating but not obliterating the SSS. Results: 23 patients (92%) had radical tumor resection achieving Simpson GI and 2 patients (8%) had subtotal tumor resection achieving Simpson GIV. There were 3 postoperative transient neurological deterioration (12%) and 2 postoperative deaths (8%). The recurrence rate in the study was 5%, with a follow-up for 24 months.
Conclusion: The benefits must be carefully weighed against the risks deciding between more aggressive, radical, or less aggressive subtotal resections. The less aggressive subtotal resections if the sinus ispartially occluded may be a reasonable choice.