Open thrombectomy and reconstruction of the rolandic vein in a parasagittal meningioma: recovering motor evoked potentials. Illustrative case.

BACKGROUND

Parasagittal meningiomas commonly invade the superior sagittal sinus (SSS) and cortical veins. Reconstructing the veins can be challenging after radical meningioma removal, especially when major venous sinuses and veins are involved. The authors present a video showcasing the reconstruction of the rolandic vein during surgery for a large parasagittal meningioma. The video shows the surgical technique and motor evoked potential recovery after venous drainage returns to normal.

OBSERVATIONS

A 59-year-old woman had been experiencing progressive weakness in her right lower limb over the past year. Magnetic resonance imaging revealed a consistent enhanced mass in the left parasagittal region over the motor area, indicating meningioma. Magnetic resonance venography showed a complete blockage of the SSS. The patient experienced the loss of motor evoked potentials after tumor removal and thrombosis of the rolandic vein. An open thrombectomy was performed, and the vein was reconnected to the SSS. The patient recovered her basal motor evoked potential.

LESSONS

The video of a rolandic vein reconstruction emphasizes the significance of preserving and restoring venous blood flow in eloquent areas. Monitoring is crucial during meningioma surgery involving the SSS and cortical veins in the motor area to identify and reverse any motor and sensory deficits, ensuring optimal resection while maintaining the patient's quality of life. https://thejns.org/doi/10.3171/CASE24601.