Results with judicious modern neurosurgical management of parasagittal and falcine meningiomas

Clinical article

Restricted access

Object

The management of parasagittal and falcine meningiomas centers around the relationship between the tumor and the venous anatomy of the superior sagittal sinus (SSS) and the bridging veins. The present study aims to address surgical outcomes in a focused cohort of these patients for which there is not clinical equipoise between radiosurgery and transcranial resection.

Methods

The clinical outcomes of patients undergoing surgical removal of parasagittal and falcine meningiomas at the authors' institution over an 18-year period were analyzed. Analysis was limited to patients with large, symptomatic, or rapidly growing tumors, for whom radiosurgery was not a good option. Tumor control was assessed using Kaplan-Meier analysis, and specific attention was paid to the relationship between the tumor and the SSS, and its impact on tumor control and outcome.

Results

The authors identified 135 patients with large, symptomatic, and/or growing parasagittal/falcine meningiomas who underwent resection at their institution between 1991 and 2007. The median length of follow-up was 7.6 years (range 1.7–18.6 years). The SSS was found to be invaded in 61 of 135 cases. In 6 cases the sinus was completely occluded. In 33 of the remaining 55 cases, the tumor invading the sinus was able to be removed with simple microsurgical techniques. There was no difference in rates of tumor control in patients who received subtotal resection for a WHO Grade I tumor, followed by close observation, compared with those undergoing gross-total resection, primarily because no cases were observed in which the tumor remnant in the SSS demonstrated interval growth on serial imaging studies. Of the patients in this series, 19% experienced at least one neurological, medical, or surgical complication.

Conclusions

Importantly, these data provide a more modern estimate of the expected outcomes that can be obtained with treatment of these tumors, in which a combination of image guidance, advanced microsurgical tools, and conformal radiation treatments is used.

Abbreviations used in this paper: CRT = conformal radiotherapy; EGFR = epidermal growth factor receptor; GTR = gross-total resection; SRS = stereotactic radiosurgery; SSS = superior sagittal sinus; STR = subtotal resection.

Article Information

Address correspondence to: Michael W. McDermott, M.D., Department of Neurological Surgery, University of California at San Francisco, 505 Parnassus Avenue, Box 0112, San Francisco, California 94143. email: mcdermottm@neurosurg.ucsf.edu.

Please include this information when citing this paper: published online October 15, 2010; DOI: 10.3171/2010.9.JNS10646.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Postoperative tumor control after surgery for parasagittal and falcine meningiomas; a graphic depiction of the frequency of sinus invasion and sinus occlusion in our patients, and the methods by which their disease was managed. Rates of recurrence for each group are noted.

  • View in gallery

    Kaplan-Meier survival plot for patients with a WHO Grade I tumor who were not treated with early postoperative radiosurgery, comparing recurrence/progression-free survival for patients who underwent GTR versus intentional STR in which tumor was left in the SSS or attached to bridging cortical veins. NS = not significant.

References

1

Agnelli GPiovella FBuoncristiani PSeveri PPini MD'Angelo A: Enoxaparin plus compression stockings compared with compression stockings alone in the prevention of venous thromboembolism after elective neurosurgery. N Engl J Med 339:80851998

2

Cage TALamborn KRWare MLFrankfurt AChakalian LBerger MS: Adjuvant enoxaparin therapy may decrease the incidence of postoperative thrombotic events though does not increase the incidence of postoperative intracranial hemorrhage in patients with meningiomas. J Neurooncol 93:1511562009

3

Chung SBKim CYPark CKKim DGJung HW: Falx meningiomas: surgical results and lessons learned from 68 cases. J Korean Neurosurg Soc 42:2762802007

4

Colli BOCarlotti CG JrAssirati JA JrDos Santos MBNeder LDos Santos AC: Parasagittal meningiomas: follow-up review. Surg Neurol 66:3 SupplS20S282006

5

Giombini SSolero CLLasio GMorello G: Immediate and late outcome of operations for parasagittal and falx meningiomas. Report of 342 cases. Surg Neurol 21:4274351984

6

Kinjo Tal-Mefty OKanaan I: Grade zero removal of supratentorial convexity meningiomas. Neurosurgery 33:3943991993

7

Kleihues PSobin LH: World Health Organization classification of tumors. Cancer 88:28872000

8

Kondziolka DFlickinger JCPerez B: Judicious resection and/or radiosurgery for parasagittal meningiomas: outcomes from a multicenter review. Neurosurgery 43:4054141998

9

Kondziolka DLevy EINiranjan AFlickinger JCLunsford LD: Long-term outcomes after meningioma radiosurgery: physician and patient perspectives. J Neurosurg 91:44501999

10

Kondziolka DMathieu DLunsford LDMartin JJMadhok RNiranjan A: Radiosurgery as definitive management of intracranial meningiomas. Neurosurgery 62:53602008

11

Korshunov AGTimirgaz VVKalinina EEKozlov AV: [The characteristics of the histological structure of parasagittal meningiomas and their effect on postoperative recurrence.]. Zh Vopr Neirokhir Im N N Burdenko 4:10151996. (Russian)

12

Kozlov AVGabibov GAKonovalov ANKorshunov AGTimirgaz VVKalinina EE: Optimization of surgical strategy in parasagittal meningiomas. A 1605-case study. Clin Neurol Neurosurg 99:Suppl 1S61997

13

Nishimoto A: [Parasagittal and falx meningiomas—surgical technique.]. No Shinkei Geka 2:17221974. (Jpn)

14

Nowak AMarchel A: Surgical treatment of parasagittal and falx meningiomas. Neurol Neurochir Pol 41:3063142007

15

Simpson D: The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry 20:22391957

16

Sindou M: Meningiomas invading the sagittal or transverse sinuses, resection with venous reconstruction. J Clin Neurosci 8:Suppl 18112001

17

Sindou MHallacq P: Venous reconstruction in surgery of meningiomas invading the sagittal and transverse sinuses. Skull Base Surg 8:57641998

18

Sindou MHallacq POjemann RGLaws ER JrAggressive vs. conservative treatment of parasagittal meningiomas involving the superior sagittal sinus. Al-Mefty OOrigitano TCHarkey HL: Controversies in Neurosurgery New YorkThieme Medical Publishers1996. 8089

19

Sindou MWydh EJouanneau ENebbal MLieutaud T: Long-term follow-up of meningiomas of the cavernous sinus after surgical treatment alone. J Neurosurg 107:9379442007

20

Sindou MPAlvernia JE: Results of attempted radical tumor removal and venous repair in 100 consecutive meningiomas involving the major dural sinuses. J Neurosurg 105:5145252006

21

Smith JSLal AHarmon-Smith MBollen AWMcDermott MW: Association between absence of epidermal growth factor receptor immunoreactivity and poor prognosis in patients with atypical meningioma. J Neurosurg 106:103410402007

22

Sughrue MESanai NShangari GParsa ATBerger MSMc-Dermott MW: Outcome and survival following primary and repeat surgery for World Health Organization Grade III meningiomas. Clinical article. J Neurosurg 113:2022092010

TrendMD

Cited By

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 113 113 42
Full Text Views 167 167 10
PDF Downloads 144 144 7
EPUB Downloads 0 0 0

PubMed

Google Scholar