Superior Sagittal Sinus Invasion Research Articles

Predictors of salvage therapy for parasagittal meningiomas treated with primary surgery, radiosurgery, or surgery plus adjuvant radiotherapy

ObjectiveParasagittal meningiomas (PM) are treated with primary microsurgery, radiosurgery (SRS), or surgery with adjuvant radiation. We investigated predictors of tumor progression requiring salvage surgery or radiation treatment. We sought to determine whether primary treatment modality, or radiologic, histologic, and clinical variables were associated with tumor progression requiring salvage treatment. MethodsRetrospective study of 109 consecutive patients with PMs treated with primary surgery, radiation (RT), or surgery plus adjuvant RT (2000–2017) and minimum 5 years follow-up. Patient, radiologic, histologic, and treatment data were analyzed using standard statistical methods. ResultsMedian follow up was 8.5 years. Primary treatment for PM was surgery in 76 patients, radiation in 16 patients, and surgery plus adjuvant radiation in 17 patients. Forty percent of parasagittal meningiomas in our cohort required some form of salvage treatment. On univariate analysis, brain invasion (OR: 6.93, p < 0.01), WHO grade 2/3 (OR: 4.54, p < 0.01), peritumoral edema (OR: 2.81, p = 0.01), sagittal sinus invasion (OR: 6.36, p < 0.01), sagittal sinus occlusion (OR: 4.86, p < 0.01), and non-spherical shape (OR: 3.89, p < 0.01) were significantly associated with receiving salvage treatment. On multivariate analysis, superior sagittal sinus invasion (OR: 8.22, p = 0.01) and WHO grade 2&3 (OR: 7.58, p < 0.01) were independently associated with receiving salvage treatment. There was no difference in time to salvage therapy (p = 0.11) or time to progression (p = 0.43) between patients receiving primary surgery alone, RT alone, or surgery plus adjuvant RT. Patients who had initial surgery were more likely to have peritumoral edema on preoperative imaging (p = 0.01). Median tumor volume was 19.0 cm3 in patients receiving primary surgery, 5.3 cm3 for RT, and 24.4 cm3 for surgery plus adjuvant RT (p < 0.01). ConclusionSuperior sagittal sinus invasion and WHO grade 2/3 are independently associated with PM progression requiring salvage therapy regardless of extent of resection or primary treatment modality. Parasagittal meningiomas have a high rate of recurrence with 80.0% of patients with WHO grade 2/3 tumors with sinus invasion requiring salvage treatment whereas only 13.6% of the WHO grade 1 tumors without sinus invasion required salvage treatment. This information is useful when counseling patients about disease management and setting expectations.

Gigantic Exteriorized Frontal Meningioma: An Exceptional Clinical Entity

Background and Importance: Meningiomas are usually benign tumors. Depending on their location and size, dealing with them can be problematic. We report an exceptional case of gigantic frontal meningioma. Its diagnosis was misleading and the excision laborious. Case Presentation: A 29-year-old patient who presented gradually over 5 years, developed behavioral disorders then swelling of the vertex at the frontal level and decreased visual acuity. Physical examination on admission revealed a median frontal swelling slightly lateralized to the left axis of approximately 10 cm, hard, covered with the healthy, severe frontal syndrome, and decreased visual acuity. Computerized tomography (CT) scan showed a voluminous medial frontal lesion lateralized to the left, with irregular limits, superior sagittal sinus invasion, brain engagement under the scythe, heterogeneous contrast taking, and significant osteolysis first evoking tumor metastasis. Magnetic resonance imaging (MRI) suggested a meningioma. The resection was macroscopically complete. Dural and cranial plasty was performed. The postoperative follow-up was simple. Histology concluded that the meningioma was grade 1 based on the world health organization (WHO) classification. Conclusion: Late-diagnosis meningiomas can take on very large proportions and pose management problems while seriously engaging the patient functional and vital prognosis.

Compensation pathways for venous drainage of the brain in superior sagittal sinus occlusion by parasagittal meningioma

This study aims to determine the existing pathways of collateral cerebral circulation in parasagittal meningiomas that cause superior sagittal sinus occlusion based on literature review and analysis of own clinical observations. Results of clinical and instrumental examination of 221 patients treated in Dnipropetrovsk Regional Clinical Hospital named after I.I. Mechnikov from 2000 to 2021 were subjected to retrospective and prospective analysis. Inclusion criteria were: patient age of 18+, parasagittal extracerebral tumor according to computed tomography/magnetic resonance imaging, histologically verified meningioma, superior sagittal sinus occlusion (type V-VI according to M.P. Sindou and J.E. Alvernia) according to selective cerebral angiography. This study is based on the analysis of examination of 43 patients who met the inclusion criteria. The selected patients were analyzed for demography (sex, age), brain computed tomography/magnetic resonance imaging before and after intravenous contrast enhancement, and computed tomography angiography and selective cerebral angiography data. Transformed venous drainage pathways were analyzed depending on the location of superior sagittal sinus occlusion by parasagittal meningioma: anterior, middle, or posterior third of the superior sagittal sinus. It was determined that preoperative diagnosis of parasagittal meningiomas that, based on brain computed tomography/magnetic resonance imaging, has signs of type V or VI superior sagittal sinus invasion according M.P. Sindou and J.E. Alvernia, must include selective cerebral angiography. Dynamic images of selective cerebral angiography in the venous phase allows to fully assess the established pathways of collateral blood flow and the blood flow direction. Information on collateral venous circulation in case of superior sagittal sinus occlusion by parasagittal meningioma is extremely important in a surgery planning. It helps avoiding iatrogenic damage to eloquent veins, which increases radical tumor removal with maintaining/improving a patient’s functional state in the early postoperative period and improving long-term treatment outcomes.

Risk factors for peritumoral edema after radiosurgery for intracranial benign meningiomas: a long-term follow-up in a single institution.

Peritumoral edema (PTE) is recognized as a complication following stereotactic radiosurgery (SRS). The aim of this paper was to evaluate the risk of post-SRS PTE for intracranial benign meningiomas and determine the predictive factors. Between 2006 and 2021, 227 patients with 237 WHO grade I meningiomas were treated with Novalis linear accelerator SRS. All patients were treated with a single-fraction dose of 11-20 Gy (median 14 Gy). The median tumor volume was 3.32 cm3 (range 0.24-51.7 cm3). The median follow-up was 52 months (range 12-178 months). The actuarial local tumor control rates at 2, 5, and 10 years after SRS were 99.0%, 96.7%, and 86.3%, respectively. Twenty-seven (11.9%) patients developed new or worsened post-SRS PTE, with a median onset time of 5.2 months (range 1.2-50 months). Only 2 patients developed post-SRS PTE after 24 months. The authors evaluated factors related to new-onset or worsened PTE after SRS. In univariate analysis, initial tumor volume > 10 cm3 (p = 0.03), total marginal dose > 14 Gy (p < 0.001), preexisting edema (p < 0.0001), tumor location (p < 0.001), parasagittal location (p < 0.0001), superior sagittal sinus (SSS) involvement (p < 0.0001), and SSS invasion (p < 0.015) were found to be significant risk factors. In multivariate analysis, total marginal dose > 14 Gy (HR 3.38, 95% CI 1.37-8.33, p = 0.008), preexisting SRS edema (HR 12.86, 95% CI 1.09-4.15, p < 0.0001), tumor location (HR 2.13, 95% CI 1.04-3.72, p = 0.027), parasagittal location (HR 8.84, 95% CI 1.48-52.76, p = 0.017), and SSS invasion (HR 0.34, 95% CI 0.13-0.89, p = 0.027) were significant risk factors. Twelve (5.3%) patients were symptomatic. Ten of 27 patients had complete resolution of neurological symptoms and edema improvement with steroid treatment. Steroid treatment failed in 2 patients, who subsequently required resection for PTE. Radiosurgery is a safe and effective method of treating benign intracranial meningiomas according to long-term follow-up. We also identified total marginal dose > 14 Gy, preexisting PTE, parasagittal location, and SSS invasion as predictors of post-SRS PTE. Risk factors for post-SRS PTE should be considered in meningioma treatment.

Diploic veins as collateral venous pathways in patients with dural venous sinus invasion by meningiomas.

Although it is known that diploic veins frequently communicate with the dural venous sinuses, the role of diploic veins in patients with venous sinus invasion from meningiomas remains unknown. We retrospectively examined the medical records of 159 patients who underwent their first craniotomies for intracranial meningiomas. Contrast-enhanced magnetic resonance imaging was used to evaluate diploic vein routes, and digital subtraction angiography (DSA) was used to evaluate diploic vein blood flow. When high blood flow was visualized concurrently with the venous sinuses, the veins were classified as of the "early type." Diploic vein routes were classified into five routes. DSA was performed in 110 patients, with 14 showing superior sagittal sinus (SSS) invasion (SSS group) and 23 showing non-SSS venous sinus invasion (non-SSS group). The proportion of early type diploic veins was significantly higher in the SSS group (27.1%) than in other patients (patients without venous sinus invasion, 2.1%; non-SSS, 4.3%) (p < 0.01). In patients not in the SSS group, diploic veins were sacrificed during craniotomy in 76 patients, including four patients with veins of the early type. No patients demonstrated new neurological deficits postoperatively. In the SSS group, diploic veins were sacrificed in all patients, and early type diploic veins were cut in five patients. Two of these five patients showed postoperative neurological deficits. In the SSS group, diploic veins may function as collateral venous pathways, and attention is recommended for their interruption. In patients without SSS invasion, diploic veins, even of the early type, can be sacrificed.

Tumor recurrence in parasagittal and falcine atypical meningiomas invading the superior sagittal sinus.

Objective: Parasagittal and falcine meningiomas are still a challenge in terms of surgical resection. Although maximal safe resection is the main therapeutic approach, numerous postoperative complications can still occur depending on the locations of these tumors. Moreover, previous studies have reported that parasagittal meningiomas have a higher recurrence rate than meningiomas with other locations. Patients, Materials and Methods: We retrospectively reviewed 21 patients with parasagittal and falcine atypical meningiomas [World Health Organization (WHO) grade II], nine of whom had their superior sagittal sinus (SSS) invaded by the tumor. We reviewed the demographic information, operative notes, pathological reports, and clinical and imagistic follow-up reports of each patient over a 5-year time span. Results: All the patients were surgically treated, and the tumor removal was grade II according to Simpson’s grading system in 47.6% and grade III in 19% of the cases. The SSS was invaded in 42.9% of the patients. No immediate mortality or morbidity was revealed by our study. Tumor recurrence/progression documented on postoperative imaging amounted to 14.3% and 19%, 12 and 24 months after surgery, respectively. Furthermore, 36, 48 and 60 months after the surgery, the recurrence rate remained the same, namely in 9.5% of the cases. The recurrence was higher in patients with SSS invasion than in patients with no SSS invasion. The tumor recurrence was slightly more predominant in women, i.e., 6% higher than in the male group. Conclusions: In our group of patients with parasagittal and falcine meningiomas, we report a 47.6% Simpson II resection rate and 19% Simpson III resection rate associated with a very low complication rate and no immediately postoperative morbidity and mortality, compared to more aggressive techniques. The recurrence of parasagittal meningiomas predominated after grade III and IV Simpson resection and dural sinus invasion was a negative predictive factor for recurrence. Therefore, the surgery of parasagittal and falcine meningiomas is beneficial, both for tumor control, but also for improving neurological outcome. Aggressive meningioma resection should be balanced with the increased neurosurgical risk.

Superior Sagittal Sinus Invasion by Malignant Glioma: Case Report and Literature Review

AbstractAnaplastic oligodendrogliomas (AOs) correspond to ∼ 23% of all oligodendrogliomas. They correspond to a tumor with malignant histological characteristics, focal or diffuse, associated with a worse prognosis. In the present case report, we describe the case of a 30-year-old female submitted to resection of a right parietal lesion whose histology showed to be an AO. She underwent complementary treatment with chemotherapy and radiotherapy according to the Roger Stupp protocol. Four years after the initial diagnosis, there was tumor recurrence within the superior sagittal sinus, with no evidence of recurrence elsewhere. In the literature, we have found no similar published case reinforcing the rarity of this condition

Incidentally Detected Pulmonary Metastasis from Recurrent Atypical Meningioma with Superior Sagittal Sinus Invasion – Case Report and Literature Review

Meningioma is a common brain tumor but despite its high prevalence, extracranial metastasis is really rare, as it may be seen in lung, bone, intraspinal, liver and cervical lymph nodes decreasingly. We report a case of metastases to lung incidentally founded from an intracranial recurrent atypical meningioma with superior sagittal sinus invasion previously treated with good control. This report highlights that in the rare case of unique incidentally founded pulmonary lesion and apparent control of the intracranial disease, the differential diagnosis of metastastic meningioma, primary lung meningioma or others lung tumor can be very challenging . The revision of pertinent literature suggests that the invasion of venous sinuses should be considered as a major risk factor for distant metastases.

Pilomatrix Carcinoma of the scalp. A case report and review of the literature

Pilomatrix Carcinoma (PC) is a rare and malignant dermo-hypodermic tumor. Only 11 cases were reported in patients younger than 18 years old and only 13 cases were reported on the scalp. We report the case of a 15-year-old woman who underwent cyst excision on the vertex. Anatomopathology shed light trichilemmal cyst. Five months later, she presented a first local recurrence. The tumor was removed with wide margin. Anatomopathology shed light PC. No adjuvant therapy was performed. The patient presented a second recurrence 3 months later with a parietal bone and superior sagittal sinus invasion and a lung metastasis. She underwent a craniotomy and radiochemotherapy. A third local recurrence was detected 4 months later. Three more lines of chemotherapy were performed without success. PC is a locally aggressive tumour, with a high rate of local recurrences and metastases. PC arises de novo or through malignant transformation of a pilomatrixoma. PC were observed frequently in the white male over 50 years old. The histological diagnosis is difficult to prove. Treatment consists of a wide surgical excision. Peritumoral margins are not codified. Because of most cases are on the face and neck, Mohs Micrographic Surgery seems to be a good modality to limit margins. Radiation therapy is an adjuvant treatment. Chemotherapy can be used in metastasis case. PC is a rare malignant tumor with high rate of disease relapse. Histological diagnosis is difficult and treatment is not standardized. Surgical procedure with wide margins is recommended to avoid the large recurrence when the staging shows no metastasis.

Non-thrombotic superior sagittal sinus occlusion with intracranial hypertension following metastatic Burkitt′s lymphoma

Intracranial metastasis is a known complication of Burkitt's lymphoma, however, superior sagittal sinus invasion by dural metastasis from Burkitt's lymphoma is rare. We report a young adult, known case of Burkitt's lymphoma, who presented with features of raised intracranial pressure secondary to dural sinus invasion from metastasis. Prompt radiotherapy to these lesions can bring about recanalization of the sinus with elevation of symptoms.

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

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.