Performed Tumor Resection Research Articles

Development of microsurgical forceps equipped with haptic technology for in situ differentiation of brain tumors during microsurgery

The stiffness of human cancers may be correlated with their pathology, and can be used as a biomarker for diagnosis, malignancy prediction, molecular expression, and postoperative complications. Neurosurgeons perform tumor resection based on tactile sensations. However, it takes years of surgical experience to appropriately distinguish brain tumors from surrounding parenchymal tissue. Haptics is a technology related to the touch sensation. Haptic technology can amplify, transmit, record, and reproduce real sensations, and the physical properties (e.g., stiffness) of an object can be quantified. In the present study, glioblastoma (SF126-firefly luciferase-mCherry [FmC], U87-FmC, U251-FmC) and malignant meningioma (IOMM-Lee-FmC, HKBMM-FmC) cell lines were transplanted into nude mice, and the stiffness of tumors and normal brain tissues were measured using our newly developed surgical forceps equipped with haptic technology. We found that all five brain tumor tissues were stiffer than normal brain tissue (p < 0.001), and that brain tumor pathology (three types of glioblastomas, two types of malignant meningioma) was significantly stiffer than normal brain tissue (p < 0.001 for all). Our findings suggest that tissue stiffness may be a useful marker to distinguish brain tumors from surrounding parenchymal tissue during microsurgery, and that haptic forceps may help neurosurgeons to sense minute changes in tissue stiffness.

Appendiceal goblet cell adenocarcinoma newly classified by WHO 5th edition: a case report (a secondary publication)

BackgroundAppendiceal goblet cell adenocarcinoma (AGCA) is a newly proposed cancer type in the 5th edition of the WHO Classification of Tumours in 2019. We experienced this rare form of appendiceal primary neoplasm.Case presentationAn 85-year-old male presented a positive fecal occult blood test. A series of imagings revealed a type 1 tumor, located on the appendiceal orifice. The subsequent biopsy made the diagnosis of signet-ring cell carcinoma. Consequently, he underwent the laparoscopic-assisted ileocecal resection. Initially, the tumor was suspected to be a Goblet cell carcinoid (GCC). There was a discrepancy between the histological and immunostaining findings: the tumor cells exhibited morphological similarities to GCCs, however displayed limited staining upon immunostaining. Ultimately, we concluded that the tumor should be classified as AGCA, by following WHO 5th Edition. AGCA represents a newly categorized subtype of adenocarcinomas. Because of our preoperative suspicion of malignancy, we performed tumor resection with regional lymph node dissection, despite the fact that most appendiceal malignant tumors are typically identified after an appendectomy.ConclusionWe experienced a case that provides valuable insights into the comprehension of AGCA, a recently established pathological entity in the WHO 5th Edition. This article is an acceptable secondary publication of a case report that appeared in Azuma et al. (J Jpn Surg Assoc 83:1103–1108, 2022)

LYMPHOME DIFFUS A GRANDES CELLULES B REVELE PAR UNE INVAGINATION INTESTINALE CHEZ LE GRAND ENFANT : A PROPOS D’UN CAS ET REVUE DE LA LITTERATURE

Intussusception occurs when an intestinal segment and its mesentery penetrate and become embedded in the downstream intestinal segment, forming a mass called an “intussusception sausage”. It is known that it can occur on a tumor in older children. Observation: We report the case of a 10-year-old child who was admitted to the emergency room of the Regional Hospital Center of Sokodé/Togo for chronic, recurrent abdominal pain and constipation for 2 months. The diagnosis of intestinal intussusception suggested during the clinical examination was confirmed on abdominal ultrasound: ceco-colo-colicintussusception. The tumor cause of the intussusception was determined intraoperatively during laparotomy. We performed tumor resection and intestinal anastomosis. The histological examination of the tumor specimen revealed a diffuse large B-cell lymphoma. The evolution after a course of chemotherapy was satisfactory and the two-year follow-up showed no recurrence. Conclusion: Intestinal intussusceptions can be a way of revealing tumors when they occur beyond early childhood. The precision of the benign or malignant nature of these tumors is crucial and determining for the treatment and the prognosis. Keywords: Intestinal intussusception, child, tumor, treatment, prognosis

SURG-01. DIFFERENTIATION OF GLIOBLASTOMA AND MALIGNANT MENINGIOMA FROM NORMAL BRAIN BY TISSUE STIFFNESS UTILIZING MICROSURGICAL FORCEPS EQUIPPED WITH HAPTICS TECHNOLOGY

Abstract Stiffness of human cancers strongly correlate with their pathology, and it is reported that stiffness can be used as a biomarker. Furthermore, comprehensive analysis has suggested the usefulness of cancer stiffness in diagnosis and malignancy prediction and its association with molecular expression, as well as its potential for predicting and diagnosing postoperative complications. Neurosurgeons perform tumor resection relying on the sensations that they feel with their own fingertips (tactile sensation), but it takes years of surgical experience to accurately distinguish brain tumor from the surrounding normal brain tissue. Haptics is a new technology regarding touching sensation. Especially, our technology, real haptics, can communicate, record, and reproduce the real sensation. It is also possible to measure and analyze the physical property such as stiffness of the touching object from the obtained haptic data. We developed a surgical forceps equipped with haptics technology to distinguish brain tumor tissue from surrounding normal brain tissue. three glioblastoma cell lines (SF126, U87, U251) and a malignant meningioma cell line (IOMM-Lee) were each transplanted intracranially into 5 nude mice. Tumor size was periodically monitored and mice were euthanized at appropriate time points. The stiffness of the tumor and normal brain tissue was measured using a master-slave integrated surgical forceps prototype. The results statistically showed that all four types of brain tumor tissues were stiffer than normal brain tissues. (p = 0.001) In addition, malignant meningioma was statistically stiffer than glioblastomas. (p = 0.025) This result is consistent with actual surgical sensations. We have shown that our surgical forceps has the ability to distinguish pathology of brain tumors as well as to distinguish brain tumor from normal brain tissue. The forceps is also helpful for the neurosurgeons to sense minute change in tissue stiffness.

Spinal meningeal melanocytoma with direct bone metastasis: A case report and literature review

Meningeal melanocytoma is a rare benign tumor of the central nervous system. An intradural extramedullary tumor at C2 was accidentally discovered in a 58-year-old woman six years ago. The lesion was well-circumscribed mass on computed tomography and magnetic resonance imaging. We predicted the tumor to be a meningioma. We performed tumor resection because its gradual growth compressed the spinal cord. Intraoperatively, the tumor was dark brown and the nearby dura matter and the lamina had a pigmented lesion suggesting direct invasion. After gross total removal, the tumor was diagnosed as meningeal melanocytoma by pathological examination. Meningeal melanocytoma with direct bone metastasis are rare. We present this case with reference to previous literature.

Tailoring albumin-based theranostic PROTACs nanoparticles for enhanced NIR-II bioimaging and synergistic cancer chemo-phototherapy

PROteolysis TArgeting Chimeras (PROTACs), a developing therapeutic tool designed to dictate target proteins for proteolysis through hijacking the ubiquitin–proteasome system, show potential for cancer therapy. However, unfavorable solubility and poor permeability of traditional PROTACs lead to low bioavailability and insufficient tumor distribution, which limit their clinical applications. Herein, we report a tridentate molecular probe (PROTAC-Cy7) by a three-in-one molecular designing strategy, which integrated a warhead that binds to MCL-1, the E3 ligase ligand pomalidomide and a heptamethine cyanine linker connecting the warhead and the ligand into the same scaffold. Then, bovine serum albumin (BSA) nanoparticles (NPs) with excellent biocompatibility, nonantigenic and biosafety were utilized to manufacture water-insoluble PROTAC-Cy7. The prepared PROTAC-Cy7@BSA NPs demonstrated tumor targeting and efficient degradation of MCL-1 through specific binding to MCL-1 receptors, which are overexpressed in multiple tumors. Moreover, PROTAC-Cy7@BSA NPs can be successfully used for near-infrared-II (NIR-II) noninvasively biomedical vascular imaging and to perform tumor resection guided by intraoperative real-time imaging. Under 808 nm laser irradiation, PROTAC-Cy7@BSA NPs exhibited synergistic Chemo-Phototherapy and showed perfect tumor suppression with 100% survival rate throughout the course of 60-day monitoring period. Our work provides a simple and feasible strategy for designing multifunctional drugs to have imaging-guided tumor-targeted multimodal therapy.

Primary leiomyosarcoma of the inferior vena cava in a pediatric case: a case report and literature review

BackgroundLeiomyosarcoma is classified as a soft tissue sarcoma. In adults, leiomyosarcoma is the most common malignancy affecting the vascular system; however, vascular leiomyosarcoma in children is extremely rare as most pediatric soft tissue tumors are rhabdomyosarcomas. The survival rate is very low, and incomplete resection is a poor prognostic factor. There is also a high rate of distant recurrence, with the lungs and liver being the most common sites of metastasis. There is no established effective chemotherapy, and complete surgical resection is the only potentially curative treatment for leiomyosarcoma.Case presentationA 15-year-old female patient with no significant medical history presented with severe upper abdominal pain and was admitted. Abdominal contrast-enhanced computed tomography and magnetic resonance imaging showed a large retroperitoneal tumor protruding into the lumen of the inferior vena cava behind the liver and multiple small nodules, and metastasis to the liver was suspected. The tumor was 6 × 4 × 5 cm in diameter, located just behind the hepatic hilar structures, and was suspected to infiltrate into the right portal vein. The tumor was diagnosed as a leiomyosarcoma through an open tumor biopsy. As the multiple liver metastases were located only in the right lobe of the liver on imaging, we performed tumor resection with right hepatectomy and replacement of the inferior vena cava (IVC). The postoperative course was uneventful; however, on postoperative day 51, distant metastatic recurrences were found in the remaining liver and right lung. The patient was immediately started on chemotherapy and trabectedin proved to be the most effective drug in the treatment regimen; however, severe side effects, such as hepatotoxicity, prevented timely administration, and the patient passed away 19 months after surgery.ConclusionsIVC resection and reconstruction combined with right hepatectomy were able to be safely performed even in a pediatric case. To improve the prognosis of leiomyosarcoma with multiple metastases, an effective treatment strategy combining surgical treatment and chemotherapy, including molecularly targeted drugs, should be established as early as possible.

A Case of Tophaceous Pseudogout with Destruction of the Skull Base at the Temporomandibular Joint.

We report a case of tophaceous pseudogout that occurred in the temporomandibular joint (TMJ) and presented with skull base destruction. The patient was a 73-year-old woman, who complained of an obstructed ear sensation in December 2021. The otolaryngological examination was unremarkeable, and a computed tomography scan revealed a calcified lesion in the left TMJ. Suspected of having osteochondroma, the patient was brought to our hospital. She was performed tumor resection as much as possible under general anesthesia revealed nodular pseudogout. The patient refused to undergo total resection due to the necessary craniotomy and the risk of postoperative complications. Instead, the patient decided to undergo following-up. One year and 4months have passed since the biopsy operation, but there is no tendency to re-increase.

Laparoscopic Radical Antegrade Modular Pancreatosplenectomy via Dorsal-Caudal Artery Approach for Pancreatic Neck-Body Cancer.

Laparoscopic radical resection of the pancreatic neck is one of the most complicated radical operations for pancreatic cancer, especially for patients who have had neoadjuvant chemotherapy. Here, we present a technique to perform laparoscopic radical antegrade modular pancreatosplenectomy (L-RAMPS) using the dorsal-caudal artery approach by making full use of the high-definition vision and operation modes of the laparoscope. The innovation and optimization of this operation are provided in the protocol. Priority should be given to the dorsal resection plane, including the dorsal side of the superior mesenteric artery (SMA), the dorsal side of the pancreatic head, the root of the celiac artery (CeA), the ventral side of the left renal vessels, and the renal hilum. On the condition that the operation for pancreatic neck-body cancer is feasible and safe, the second step is to perform tumor resection en bloc surrounding the SMA and CeA from the caudal to the cephalic side to increase the rate of R0 (radical zero) resection and further prognosis.

SURG-21. DEVELOPMENT OF MICROSURGICAL FORCEPS EQUIPPED WITH HAPTICS TECHNOLOGY FOR IN SITU DIFFERENTIATION OF TUMOR TISSUE FROM NORMAL BRAIN DURING MICROSURGERY BY TISSUE STIFFNESS

Abstract Neurosurgeons perform tumor resection based on their tactile perception. However, many years of experience and training are required to appropriately differentiate tumor tissue from surrounding parenchymal tissue. It was reported that the stiffness of human cancer tissue strongly correlates with pathological tissue and it can be used as a biomarker. Comprehensive analysis also revealed that the molecular expression differs greatly between hard and soft tumors.Haptics technology measures and uses the stimulus that causes the sensation as a physical quantity. Force and tactile sensation is a sensation caused by mechanical contact with an object. Real Haptics is our main research field, which is a general term for technologies that quantify and utilize the force-tactile stimuli generated by contact with objects that exist in the real world and / or the virtual world.We have developed a microsurgical forceps equipped with haptics technology to differentiate tumor tissue from surrounding brain tissue during tumor dissection. We generated and used three glioblastoma cell lines (SF126, U87, U251) expressing proteins of firefly luciferase and mCherry. Each cell line was transplanted into forebrain of 5 nude mice. Tumor progression was regularly monitored with In Vivo Imaging System (IVIS) and mice were euthanized at the appropriate stage. Tumor and normal brain stiffness were measured by using the Master-slave integrated haptic forceps device. Importantly, all of the three glioblastomas were shown to be harder than the normal brain (p=0.047). The median stiffness of each tissue was as follows. Normal brain (n=15): 149.98 N/m, SF126 (n=5): 207.70 N/m, U87 (n=5): 214.40 N/m, U251 (n=5): 188.86 N/mThis pilot study showed that brain tumors could be differentiated by their stiffness from normal brain, and the forceps equipped with haptics technology might help the neurosurgeons to dissect tumor margin along the appropriate plane.

Artificial reconstruction for a thymoma invading superior vena cava

Artificial reconstruction for a thymoma invading superior vena cava

Giant esophageal liposarcoma with squamous cell carcinoma resected via the cervical approach: a case report

BackgroundLiposarcoma is one of the most common soft tissue sarcomas, but is extremely rarely found in the esophagus. There have been no reports of esophageal liposarcoma together with superficial carcinoma of the esophagus. Here, we report a patient who underwent complete resection of esophageal liposarcoma with carcinoma via a cervical approach.Case presentationA 66-year-old man was diagnosed with an esophageal tumor 11 years ago, but he left it untreated. He presented to our hospital with progressive dysphagia and appetite loss since the previous year. Esophagogastroduodenoscopy (EGD) showed a large pedunculated submucosal tumor (SMT) originating at the esophageal entrance, extending to the gastroesophageal junction. Additionally, there was a superficial carcinoma on the surface of the SMT, 30 cm from the incisor teeth. Three-dimensional computed tomography (3D-CT) showed a giant elongated intraluminal tumor extending downwards from the cervical esophagus. We diagnosed a giant esophageal polyp accompanied by a superficial carcinoma and performed tumor resection via a cervical approach. The excised specimen consisted of a 23.0 × 8.5 cm polypoid mass. The final diagnosis by histopathological and immunohistochemical examination was well-differentiated liposarcoma and esophageal squamous cell carcinoma. He was discharged on postoperative day 14 with drastic improvement in his swallowing ability.ConclusionWe reported an extremely rare case of esophageal liposarcoma together with esophageal squamous cell carcinoma that was successfully resected through a small cervical incision.

The Short-term Outcome of Early Oral Feeding as Recovery Protocols on Resectable Gastric Cancer

BACKGROUND: Gastric cancer is the fourth most common malignancy. Surgical resection is the only treatment. Giving early oral feeding after gastric surgery is controversial. AIM: This study aimed to provide short-term outcomes in resectable gastric cancer patients by early oral feeding. METHODS: A retrospective descriptive study with a cross-sectional approach was conducted with all gastric cancer patients treated and performed tumor resection who underwent early oral feeding protocol at RSUD Dr. Moewardi Surakarta in January 2018–August 2019. The data, especially age, gender, tumor location, resection, reconstruction, and short-term outcome (anastomotic leak and surgical site infection), were taken from the medical records. RESULTS: A total of seven patients were included in the study. Six patients were &gt;50 yearsold (60.14 + 1.29 years). Four patients (57.14%) were female. One patient (14.28%) had Roux-en-Y esophagojejunostomy anastomoses, two patients (28.57%) had a Billroth while four patients (57.15%) were performed Billroth II. There was no significant correlation between early oral feeding and short-term outcome. CONCLUSION: This description of short-term outcome in resectable gastric cancer which performed early oral feeding protocols has not shown any complications. However, this research needs further research with more significant number of samples and post-operative complications.

RT-5 Boron Neutron Capture Therapy has extended progression-free survival about recurrent malignant peripheral nerve sheath tumor - A case report

Introduction: Recurrent malignant peripheral nerve sheath tumor (MPNST) is intractable. Boron neutron capture therapy (BNCT) is a treatment using tumor-selective particle radiation, and is indicated for medical treatment for head and neck cancer, and also used for malignant glioma and malignant meningioma.<Case>20-year-old woman who has MPNST that extends from the subcutaneous tissue of the right neck to the posterior fossa. <Medical History>Chemotherapy and local irradiation(50.4Gy/28fr) for primary embryonal rhabdomyosarcoma of the right ear canal at the age six.<Current medical history>Right cervical tumor developed at 17-year-old, some chemotherapy regimens and tumor resections were performed as recurrence of rhabdomyosarcoma at the previous hospital. After she was diagnosed with MPNST in the pathology consultation at our hospital, she was irradiated with heavy ion beam 70.8Gy(RBE)/16fr and received additional chemotherapies at our department, but her tumor was refractory. Although BNCT for MPNST is not covered by health insurance in Japan, she wanted to try to be treated for BNCT. After confirming boron accumulation in the tumor (SUVmax 4.28) by FBPA-PET, tumor growth and hydrocephalus occurred while waiting for travel to Taiwan due to the spread of COVID-19 infection. She was performed tumor resection(NTR) and irradiated with SRS 20Gy/fr for the residual lesion, but tumor had a rapid recurrence from the margin of the excision cavity. Finally, she could travel about 3 months after the operation and underwent BNCT, that used neutrons and 10B-boronophenylalanine from the Tsinghua University research reactor in Taiwan. No serious adverse events including cerebral edema were observed, and dramatic tumor shrinkage was maintained after treatment. FBPA-PET of 3 months later showed accumulation in the part of the margin of the cavity, the recurrence was observed on MRI after 3 and a half months. Discussion: BNCT for refractory/recurrent MPNST showed acceptable safety and was able to prolong progression-free survival.

Evaluation of Peri-operative Outcomes Associated With Resident Involvement on Tumor Resection and Renorrhaphy During Robotic-assisted Partial Nephrectomy

ObjectiveTo evaluate perioperative outcomes of resident trainee involvement in tumor resection and renorrhaphy during robotic assisted partial nephrectomy (RAPN). Materials and MethodsWe analyzed 500 consecutive RAPN in a single surgeon prospectively maintained database. Cases with resident performed tumor resection and renorrhaphy (N = 71) were case matched on R.E.N.A.L. score and RAPN year using a greedy matching algorithm. Perioperative variables were compared to attending cases. ResultsThere were no statistically significant differences in high grade postoperative complications (resident: 3% vs attending: 6%, P = .68), positive margins (resident: 1% vs attending: 3%, P = .31), length of stay (resident: 2.0 vs attending: 2.0 days, P = .73), and 30 day readmission (resident: 7% vs attending: 11%, P = .56). However, residents had a statistically significant longer warm ischemia time (median 21 vs 15 minutes, P <.001), thus less likely to achieve trifecta (66% vs 85%, P = .02). Resident involvement had longer median operative time (197 vs 184 minutes, P = .03). No statistically significant difference in functional volume loss (P = .12) or surface intermediate base margin score (P = .66) between residents and attending was found. No difference in post-operative creatinine change was found at 1 day and 1 month (resident: 0.2 vs attending: 0.1 mg/dL, P = .4 and resident: 0.1 vs attending: 0.1 mg/dL, P = .6, respectively). ConclusionSupervised resident console involvement in tumor resection and renorrhaphy during RAPN is safe and does not increase rates of complications. Residents have longer median warm ischemia time compared to attending only cases, but this does not appear to impact post-operative renal function.

GPU-friendly data structures for real time simulation

Simulators for virtual surgery training need to perform complex calculations very quickly to provide realistic haptic and visual interactions with a user. The complexity is further increased by the addition of cuts to virtual organs, such as would be needed for performing tumor resection. A common method for achieving large performance improvements is to make use of the graphics hardware (GPU) available on most general-use computers. Programming GPUs requires data structures that are more rigid than on conventional processors (CPU), making that data more difficult to update. We propose a new method for structuring graph data, which is commonly used for physically based simulation of soft tissue during surgery, and deformable objects in general. Our method aligns all nodes of the graph in memory, independently from the number of edges they contain, allowing for local modifications that do not affect the rest of the structure. Our method also groups memory transfers so as to avoid updating the entire graph every time a small cut is introduced in a simulated organ. We implemented our data structure as part of a simulator based on a meshless method. Our tests show that the new GPU implementation, making use of the new graph structure, achieves a 10 times improvement in computation times compared to the previous CPU implementation. The grouping of data transfers into batches allows for a 80–90% reduction in the amount of data transferred for each graph update, but accounts only for a small improvement in performance. The data structure itself is simple to implement and allows simulating increasingly complex models that can be cut at interactive rates.

The Use of a CAD/CAM Surgical Obturator Without Impressions to Restore a Maxillectomy Defect

Immediate obturation of the patient undergoing maxillectomy who is not undergoing formal autologous reconstruction is important for immediate form and function of the patient. Exophytic tumors, that are large in dimension can make pre-operative obturator formation challenging. Traditional methods of obturator fabrication involve a physical or digital impression. Preoperative virtual surgical planning for tumor resection and reconstruction using free tissue transfer has become a mainstay in head and neck reconstruction. We describe a variation of this for a patient unable to undergo free tissue transfer where the authors used preoperative virtual surgical planning and CAD/CAM technologies to perform tumor resection, and fabricated an obturator based on the CT imaging alone.

SURG-24. NOVEL MALLEABLE FORCIPES FOR ENDOSCOPIC ASSISTED TECHNIQUE IN PEDIATRIC BRAIN TUMORS

Recent advances in optical devices and surgical instruments have been applied to neurosurgery. Even with modifications, one of the most serious risks is injury of neuronal and vascular structure caused by operation of surgical instruments in a narrow surgical field. Fixed instruments are not practical for pediatric brain tumor surgeries because the length of the curved or angled tip portion is limited because of the narrow entrance. We developed a novel malleable forceps to resolve the difficulties related to microsurgical procedures. The malleable forceps has two shafts with a sharp cup at the tip. The entire forceps was made of stainless steel, with a silver and nickel alloy inserted between 10 and 40 mm from the tip. In the alloy part, the surgeon can flex the forceps freely using a special cylinder. The special cylinder is useful to prevent from slipping of the cups of tip. The maximum angle that can be bent is 70 degrees vertically. We also developed a monoshaft malleable forceps. We used these flexible forcipes in the case of various pediatric brain tumors including craniopharyngioma. We performed tumor resection by anterior interhemispheric trans-lamina terminalis approach. After procedure of tumor resection using microscope, endoscope inserted around the pituitary stalk. The piece of calcified tumor could be easily removed without any complications. These forcipes can be deformed to an appropriate angle and can be applied to various cases, especially pediatric brain tumors.

Pediatric Calvarial Tumors: 10 Years of Clinical Experience and Differences From the Literature.

Very few studies have focused exclusively on pediatric calvarial tumors. These studies have primarily addressed the similarities of the cases with those reported in the literature, as opposed to their distinctive features. In contrast, the present study is the most detailed study conducted in the last 10 years that includes only pediatric calvarial tumors and highlights their differences according to the literature. A total of 31 patients with pediatric calvarial tumor surgically treated in our center between 2010 and 2020 were included in the study. The patients' files were analyzed retrospectively and 17 different preoperative, intraoperative, and postoperative parameters were determined and compared with previous studies. Except for the tumors causing lytic or sclerotic lesions, there was at least one distinguishing aspect of our series in all parameters. Despite the many distinctive features, the consensus in the treatment of calvarial tumors is to perform complete resection of the tumor and, if possible, remove some of the adjacent healthy bone. Considering the age factor, however, closure of the resulting bone defects with cranioplasty to address issues of cosmesis and intracranial pressure is yet another aspect of pediatric calvarial tumors, because pediatric cranioplasty has its own specific complications. Using intraoperative neuronavigation and performing tumor resection alone without additional craniectomy are also methods the authors use to prevent major bone defects.

Can safe and radical resection of all types of parasagittal meningiomas be achievable? —the introduction of a simplified surgical strategy

ABSTRACT Background: Surgery of parasagittal meningiomas (PSMs) is still technically challenging, for the balance between radical resection and preservation of venous circulation. In this article, we’d systemically introduce the technical nuances of a simplified strategy for radical resection of all types of PSMs. All the cases were operated by one single neurosurgeon from a single institution. Methods: Clinical charts of patients with PSMs between 2014 and 2020were retrospectively reviewed. A simplified classification method was adopted, which was based on the relationship between the tumor and superior sagittal sinus (SSS). Surgery aiming at radical resection and venous flow preservation was performed. Only in case of total occlusion of SSS, we performed tumor resection without reconstruction of the venous sinus. Results: Clinical data obtained in 55 consecutive patients (47 primary and 8 recurrent cases) were analyzed, among which 20 were with patent sinus, 27 were with partially occluded sinus and 8 were with completely occluded sinus. Forty-two (76.4%) and 13 patients (23.6%) had the same and improved functional status as compared to that of pre-operation, respectively. Four patients (7.3%) experienced transient neurological deterioration but improved to the normal level in the long-term follow-up. All patients achieved Simpson I/II radical resection. No patients suffered from post-operative recurrence in the follow-up duration of 27.05 ± 19.55 (2–91) months. Conclusion: Radical and safe resection of all types of PSMs is achievable and not difficult if the simplified surgical strategy mentioned in the article is adopted, no matter to which extent the sinus is invaded.