Resection of Meningiomas Involving Major Dural Venous Sinuses: Classification, Technique and Long Term Results.

Resection of Meningiomas Involving Major Dural Venous Sinuses: Classification, Technique and Long Term Results.

World Neurosurg. 2019 Feb 01;:

Authors: Zeeshan Q, Patel A, Cheng CY, Zhao NH, Barber J, Ghodke BV, Sekhar LN

Abstract
OBJECTIVE: Management of meningiomas with major dural venous sinus involvement is challenging. We present our case series and perspective on reconstruction of the sinuses.
METHODS: 55 patients underwent operations between 2005 and 2016 and the retrospective data were collected and analyzed.
RESULTS: Cohort was younger with a mean of 51.3 years (Range 19 - 72 ) predominantly involving the superior sagittal sinus (44 patients). Sinus involvement was classified into Group 1 (<50% of sinus, n=28), Group 2 (50-99%, n=8) and Group 3 (Total occlusion, n=19). Venous collateralization was present in 100% of Group 2 and 3 and in 36% of Group 1 occlusions. Sinus pericranii was seen in 22 patients. A gross total resection was achieved in 87.2%, and sinus reconstruction followed in thirty eight patients; 24 by direct suture and 14 by a patch graft. Pathology showed 36 (65%) WHO I, 18 (33%) WHO II, and 1 (2%) WHO III tumors. During the mean follow up of 60 months (range 1 -132 months), sinus was patent (74%) or narrowed but patent (24%) in 98% ; two recurrences (3.6%) were observed (at 24 and 120 months) .The Mean pre/postoperative KPS scores and Kaplan Meier cumulative overall/recurrence free survival were 84.2/88.1 and 90.9%/80.1 % respectively.
CONCLUSIONS: These meningiomas present in a younger population, are more likely to be WHO grade II or III, necessitating a more aggressive tumor resection strategy. Aggressive resection coupled with sinus reconstruction results in good long term surgical outcome and low recurrence rates.

PMID: 30716491 [PubMed - as supplied by publisher]

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