Microsurgical treatment of parasagittal meningiomas in central gyrus region

Abstract

Objective To evaluate the surgical methods and outcomes of parasagittal meningiomas in central gyrus region. Methods Clinical data regarding 42 parasagittal meningiomas in central gyrus region were analyzed, which were admitted into the First Affiliated Hospital of Zhengzhou University during the time from January of 2007 to January of 2015. Sagittal sinus, rolandic veins, draining veins and peritumoral brain cortices were well protected during surgeries. In case of occlusion of superior sagittal sinus, it was resected together with tumor while draining veins were protected well. Radiosurgery was postoperatively conducted for residual tumors in sagittal sinus or adhered to nearby draining veins. Results Among 42 cases of parasagittal meningiomas in central gyrus region, Simpson Ⅰ grade resection was conducted in 7 cases, Ⅱ grade resection in 17 cases, Ⅲ grade in 16 cases, and Ⅳ grade in 2 cases. Motor and sensory deficits, newly developed or worsening, were observed in 14 cases postoperatively, among which 12 cases gradually recovered in 3 months, incomplete limb paralysis remained in 2 cases, and one developed seizure. Morbidity rate was calculated to be 7% with no deaths. Forty-one patients were followed up for 1.3-9.3 years (mean 5.1 years) and the tumor recurrence rate was 12%. Two patients having received Simpson Ⅳ resection reported meningioma recurrence 1-3 year postopertively and a second surgical operation were conducted for them. Conclusion Sufficient preoperative imaging evaluation, proper intraoperative dealing with superior sagittal sinus, protection of the rolandic vein、drainage vein、peritumoral brain cortex would ensure and improve the surgical outcomes. Key words: Meningioma; Superior sagittal sinus; Microsurgery; Treatment outcome