Results with judicious modern neurosurgical management of parasagittal and falcine meningiomas

Clinical article

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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.


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.


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.


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:

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.



  • 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.



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