Resection of recurrent parasagittal meningiomas with complete obstructed superior sagittal sinus

Background: The recurrence rate of parasagittal meningiomas is high because of its pathological character of superior sagittal sinus (SSS) invasion. By the time tumors recur, the SSS are often stenotic or obstructed and offers the risk of intracranial hypertension and venous infarction. Methods: The authors present their experiences of three cases of huge, recurrent parasagittal meningiomas with total obstruction of the SSS. All three cases underwent computerized tomography (CT), magnetic resonance imaging (MRI) and digital subtraction angiography (DSA). Complete obstruction of SSS was confirmed, and on the venous phase angiography, descending, major draining veins were noticed. At surgery, radical resection of tumors, including completely obstructed SSS, was achieved without SSS reconstruction and no major draining veins sacrificed. Results: The postoperative course was uneventful. The patient, whose posterior third SSS was affected, experienced vision deterioration that cleared up within a few days. With another two patients, whose middle third SSS was affected, their paraplegia became aggravated but partially recovered shortly after. Conclusion: The obstruction of SSS in recurrent parasagittal meningiomas takes time, and during this progressive course, the collateral venous pathways developed. Meanwhile, the reversal of the normal venous flow of the major, superficial cortical draining veins was achieved. At that time, radical resection of the tumors, including the obstructed SSS, might be safe without the need for SSS reconstruction. (C) 2003 Published by Elsevier B.V.Clinical NeurologySurgeryCPCI-S(ISTP)