Intraoperative color-coded duplex sonography of the superior sagittal sinus in parasagittal meningiomas

Abstract

Summary Background Patency of the superior sagittal sinus (SSS) is a key factor in surgery of parasagittal meningiomas (PSM). The main and least invasive method of evaluation of the SSS is magnetic resonance venography (MR venography). However the efficacy of this method is limited in some cases especially in slow flow velocities. Objective Determine potentials of intraoperative color-coded duplex sonography (CCDS) for evaluation of the SSS in PSM comparing them with MR venography. Methods CCDS was conducted in 30 adult patients with PSM using linear ultrasound probe i12L-RS (Vivid E, GE) placed on the superior wall of the SSS after craniotomy. Intraoperative CCDS findings were compared with 2D time-of-flight MR venography. Results False-positive results of complete occlusion of the SSS by MR venography in our series were obtained in 7 out of 16 cases (for the anterior third of the SSS – 5 out of 6; middle third – 1 out of 8; posterior third – 1 out of 2). CCDS determined the degree of SSS invasion and differentiated invasion from compression or thrombosis of the SSS, which MR venography could not. Conclusion Intraoperative CCDS is safe and allows evaluation of SSS patency as well as venous lacunae, bridging veins and inferior sagittal sinus, classification according to degree of SSS invasion, and being more precise than MR venography it can be used to determine surgical strategy.