Retrospective review of a venous sparing approach to resection of parasagittal meningiomas.

Parasagittal meningiomas make up 20-30% of intracranial meningiomas. Their proximity to, and often invasion of, the superior sagittal sinus (SSS) may preclude complete surgical resection. Repair and reconstruction of the SSS in pursuit of Simpson grade I resection is associated with increased morbidity. We retrospectively reviewed 76 parasagittal meningiomas. Our surgical technique emphasized preservation of bridging cortical veins and the SSS. In cases where the SSS was already occluded by tumor, this portion of the sinus and adjacent falx were resected. In cases where the SSS was not occluded by tumor, maximal tumor resection without entering the SSS was performed. The post-op neurologic exam was unchanged or improved in 91% of patients. Only one patient (1%) experienced new persistent neurologic symptoms, which consisted of contralateral numbness. Sixteen patients (21%) experienced tumor recurrence that was deemed appropriate for additional intervention (radiosurgery, re-operation, or re-operation + radiosurgery). Age, sex, location, recurrence, size, presence of edema, degree of sinus involvement, or pathology were not statistically significant predictors of recurrence. Length of follow-up was the only statistically significant predictor of recurrence. A surgical strategy emphasizing preservation of cortical bridging veins and the SSS appears to be safe and effective for the treatment of parasagittal meningiomas. The use of adjuvant therapy for the treatment of residual intrasinusal tumor encountered in this approach may be reserved for cases of tumor progression.