Long-Term Outcome after Resection of Meningiomas Involving the Superior Sagittal Sinus

Aim: The role of radical resection and combined therapies of parasagittal meningiomas invading the superior sagittal sinus (SSS) on tumor control and long-term outcome are still controversial. Recent studies reported an unfavorable outcome in terms of morbidity and mortality after radical surgery compared with a partial tumor removal. The aim of this study was the evaluation of the short-term and long-term outcome in patients undergoing surgical treatment with or without resection of the SSS.

Methods: We retrospectively analyzed the data of 45 patients who underwent surgery for parasagittal meningioma between 2007 and 2014 in our institution. Demographic characteristics, clinical and radiological findings including volume of the tumor, resection Simpson grade, histological classification and outcome by measuring degree of disability (modified Rankin Scale (mRS) and extended Glasgow Outcome Scale (eGOS), were documented. Of interest were the outcomes in patients with tumor recurrences as well as the correlation of initial tumor size and treatment decision.

Result: The mean age was 59.8 years (19–85 years); 18 patients male (40%); 27 patients female (60%). The initial mean tumor volume was 45.2 cm³ (2–201 cm³). A radical resection of the tumor was achieved in 16 cases (36%); 8 (18%) cases underwent additional SSS resection. A partial tumor resection was performed in 29 cases (64%) without SSS resection. The mean postoperative residual tumor volume was 1.7 cm3 (0.26–11.9 cm³). Histology revealed World Health Organization (WHO) grade I in 38 cases (84%) and 7 cases were atypical (WHO grade II, 16%). Two patients died during their hospital stay (4%) due to surgical complications. Six (14%) out of 43 cases were lost to follow-up, leaving 37 patients with a mean follow-up time of 53.6 months. The preoperative mRS and eGOS in 43 patients changed at hospital discharge from 1 to 2 and from 7 to 5, respectively. However, overall the long-term outcome showed an excellent recovery in all patients, with a mRS of 0 or 1 and eGOS 8 or 7, respectively. During follow-up, 17 patients experienced a tumor recurrence and 6 patients underwent reoperation. A total of 6 patients underwent radiosurgery.

Conclusions: Favorable clinical outcome and long-term tumor control after partial resection of parasagittal meningioma involving the SSS were documented in this series. This treatment strategy seems not inferior to radical surgery and confirms previous reported studies.

No conflict of interest has been declared by the author(s).