Clinical value of collateral venous circulation assessment in operations of parasagittal meningiomas

Abstract

Objective To evaluate the clinical value of collateral venous circulation assessment in operations of parasagittal meningiomas (PSM). Methods A total of 71 patients with PSM were enrolled in this study who underwent surgical operations at Department of Neurosurgery, Fuzhou General Hospital from October 2011 to December 2015. The examination of MRV was conducted prior to operation to reveal the location of tumors and degrees of their invasion of the venous sinus. The collateral venous circulation was graded from 0 to 4 based on the Qureshi Collateral Circulation Assessment with certain modifications, guided by which operations were conducted and the patients' outcomes were retrospectively analyzed. Results Among the 71 patients, tumors were located in the anterior (n=12), middle (n=46) and posterior (n=13) regions of superior sagittal sinus. Collateral venous circulation was not observed (grade 0) in 26 (36.6%) cases; 8 (11.3%) patients were graded class 1; 12 (16.9%) and 25 (35.2%) patients belonged to grade 3 and 4, respectively. Simpson grade Ⅰ/Ⅱ and Ⅲ resections were achieved in 67 (94.4%) and 4 (5.6%) cases, respectively. The superior sagittal sinus was excised in 15(21.1%) cases, reconstructed in 8 (11.3%) cases and electrocoagulated in 48 (67.6%) cases. The median length of postoperative follow-up was 34 months (range 3-70 months). Fourteen (19.7%) patients reported post-operative new neurological dysfunctions or deterioration of original symptoms, and permanent neurological dysfunctions occurred in 8 (11.3%) cases. The percentages of poor outcomes in patients with grade 0-4 collateral venous circulation were 2/26, 1/8, 1/12 and 4/25, respectively, and their differences were not statistically significant (P=0.830). Postoperative venous sinus thrombosis occurred in 3 (4.2%) patients, among whom one (1.4%) was cured, one (1.4%) died and one (1.4%) reported recurrence 1 year post surgery. Conclusions Extracranial collateral venous circulation plays an important role in the design of incision. Preoperative assessment of collateral venous circulations for PSM patients help guide the venous treatment and improve their outcomes. Key words: Meningioma; Collateral circulation; Cerebral veins; Neurosurgical procedures