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Duan Z, Zhou C, Yan X, Du W, Xia X, Shi H, Su H, Zhang Y, He X, Xiong Q. Efficacy and safety of a "radical" surgical strategy in the treatment of parasagittal sinus meningioma. Front Neurol 2024; 15:1364917. [PMID: 38651111 PMCID: PMC11034519 DOI: 10.3389/fneur.2024.1364917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 03/27/2024] [Indexed: 04/25/2024] Open
Abstract
Background No standardized criteria for surgical resection of parasagittal sinus meningiomas (PSM) have been established, and different surgical strategies have been proposed. The aim of the present study was to investigate the efficacy and safety of a "radical" surgical strategy in the treatment of PSM. Methods The clinical histories, radiological findings, pathologic features, and surgical records of 53 patients with PSM admitted by the same surgical team using the "radical" surgical strategy were retrospectively analyzed between 2018 and 2023. Results Among the 53 PSM cases, 16 (30.2%) had a patent sinus proper, 28 (52.8%) had partial obstruction of the sinus proper, and 9 (17.0%) had complete obstruction of the sinus proper before the operation. During operation, Simpson grade I resection was performed in 34 (64.2%) cases and Simpson grade II in 19 (35.8%) cases. Postoperative pathologic examination suggested tumors of WHO grade I in 47 (88.7%) cases, WHO grade II in 4 (7.5%) cases, and WHO grade III in 2 (3.8%) cases. Postoperative complications primarily included a small amount of delayed intracerebral hemorrhage in 3 (5.7%) cases, exacerbation of cerebral edema in 3 (5.7%) cases, exacerbation of motor and sensory deficits in 4 (7.5%) cases, and intracranial infection in 2 (3.8%) cases. There were no cases of death or new-onset neurological dysfunction. Dizziness and headache symptoms improved to varying degrees, and a seizure-free status was achieved postoperatively. Excluding one case lost to follow-up, the average follow-up period was 33 months, and there were no cases of recurrence. Conclusion A "radical" strategy for the surgical management of PSM is effective, safe, and simple to perform, provided that the sagittal sinus is properly managed and its associated veins are protected.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Qijiang Xiong
- Department of Neurosurgery, the Affiliated Yongchuan Hospital of Chongqing Medical University, Chongqing, China
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Khanna O, Barsouk A, Momin AA, Mahtabfar A, Andrews CE, Hafazalla K, Lan M, Patel PD, Baldassari MP, Andrews DW, Evans JJ, Farrell CJ, Judy KD. Predictors of recurrence after surgical resection of parafalcine and parasagittal meningiomas. Acta Neurochir (Wien) 2023; 165:4175-4182. [PMID: 37987849 DOI: 10.1007/s00701-023-05848-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/10/2023] [Indexed: 11/22/2023]
Abstract
PURPOSE Owing to their vicinity near the superior sagittal sinus, parasagittal and parafalcine meningiomas are challenging tumors to surgically resect. In this study, we investigate key factors that portend increased risk of recurrence after surgery. METHODS This is a retrospective study of patients who underwent resection of parasagittal and parafalcine meningiomas at our institution between 2012 and 2018. Relevant clinical, radiographic, and histopathological variables were selected for analysis as predictors of tumor recurrence. RESULTS A total of 110 consecutive subjects (mean age: 59.4 ± 15.2 years, 67.3% female) with 74 parasagittal and 36 parafalcine meningiomas (92 WHO grade 1, 18 WHO grade 2/3), are included in the study. A total of 37 patients (33.6%) exhibited recurrence with median follow-up of 42 months (IQR: 10-71). In the overall cohort, parasagittal meningiomas exhibited shorter progression-free survival compared to parafalcine meningiomas (Kaplan-Meier log-rank p = 0.045). On univariate analysis, predictors of recurrence include WHO grade 2/3 vs. grade 1 tumors (p < 0.001), higher Ki-67 indices (p < 0.001), partial (p = 0.04) or complete sinus invasion (p < 0.001), and subtotal resection (p < 0.001). Multivariable Cox regression analysis revealed high-grade meningiomas (HR: 3.62, 95% CI: 1.60-8.22; p = 0.002), complete sinus invasion (HR: 3.00, 95% CI: 1.16-7.79; p = 0.024), and subtotal resection (HR: 3.10, 95% CI: 1.38-6.96; p = 0.006) as independent factors that portend shorter time to recurrence. CONCLUSION This study identifies several pertinent factors that confer increased risk of recurrence after resection of parasagittal and parafalcine meningiomas, which can be used to devise appropriate surgical strategy to achieve improved patient outcomes.
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Affiliation(s)
- Omaditya Khanna
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, 19107, USA
| | - Adam Barsouk
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, USA
| | - Arbaz A Momin
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, 19107, USA
| | - Aria Mahtabfar
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, 19107, USA
| | - Carrie E Andrews
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, 19107, USA
| | - Karim Hafazalla
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, 19107, USA
| | - Matthews Lan
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, 19107, USA
| | - Pious D Patel
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, 19107, USA
| | - Michael P Baldassari
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, 19107, USA
| | - David W Andrews
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, 19107, USA
| | - James J Evans
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, 19107, USA
| | - Christopher J Farrell
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, 19107, USA
| | - Kevin D Judy
- Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, 19107, USA.
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Chen Z, Lin T, Liu D, Zeng Y, Zhang X, Deng B, Guo D, Shi T, Lu M. Comparison of Short-Term Surgery Outcomes and Clinical Characteristics Between Elderly and Non-Elderly Patients with Middle Third Parasagittal and Parafalcine Meningiomas. Neuropsychiatr Dis Treat 2023; 19:2331-2340. [PMID: 37928167 PMCID: PMC10624188 DOI: 10.2147/ndt.s428341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/24/2023] [Indexed: 11/07/2023] Open
Abstract
Purpose This study aims to compare the short-term surgery outcomes of the resection of meningiomas and clinical characteristics between elderly and non-elderly patients. Patients and Methods This retrospective study included patients who underwent a resection of middle third parasagittal and parafalcine meningiomas between January 2011 and December 2020. All lesions arise from the middle third of the parafalcine or infiltrate superior sagittal sinus (SSS). The clinical characteristics studied included neurological deficit, peritumoral brain edema (PTBE), SSS invasion, tumor size, and symptoms; perioperative complications, and short-term surgery outcomes including neurological deficit, operative blood loss, postoperative hospitalization duration, and WHO classification were compared. Results A total of 43 elderly patients and 63 non-elderly patients were included. Compared with non-elderly patients, elderly patients had larger lesions (P = 0.013) and presented with a larger PTBE (P = 0.019). SSS blockage was identified in 28.57% of elderly patients and 19.57% of non-elderly patients. Compared with non-elderly patients, elderly patients tended to suffer from more aggressive lesions (WHO II/III meningioma 6 vs 3, P = 0.154) and presented with longer postoperative hospital stays (17.25 ± 5.8 vs 13.50 ± 3.8, P = 0.009); conversely, while the non-elderly patients experienced more blood loss (P = 0.022) and had more perioperative reoperations (3 vs 1). No significant difference in neurological deficit was detected between the two groups (P = 0.97). After total tumor resection, patients with neurological deficits in both groups can recover during the follow-up period. Conclusion Among the 106 patients with middle third parasagittal and falx meningiomas in our hospital, elderly patients had larger lesions, presented with more severe PTBE, and had longer postoperative hospital stays than younger patients. Conversely, younger patients had more blood loss and serious complications than elderly patients. Postoperative neurological dysfunction in elderly patients was similar to that in middle-aged and young patients.
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Affiliation(s)
- Zhijie Chen
- Department of Neurosurgery, Guangdong 999 Brain Hospital, Medical College of Jinan University, Guangzhou, Guangdong, 510000, People's Republic of China
| | - Tao Lin
- Department of Neurosurgery, Guangdong 999 Brain Hospital, Medical College of Jinan University, Guangzhou, Guangdong, 510000, People's Republic of China
| | - Da Liu
- Department of Neurosurgery, Guangdong 999 Brain Hospital, Medical College of Jinan University, Guangzhou, Guangdong, 510000, People's Republic of China
| | - Yongqin Zeng
- Department of Neurosurgery, Guangdong 999 Brain Hospital, Medical College of Jinan University, Guangzhou, Guangdong, 510000, People's Republic of China
| | - Xubiao Zhang
- Department of Neurosurgery, Guangdong 999 Brain Hospital, Medical College of Jinan University, Guangzhou, Guangdong, 510000, People's Republic of China
| | - Bin Deng
- Department of Neurosurgery, Guangdong 999 Brain Hospital, Medical College of Jinan University, Guangzhou, Guangdong, 510000, People's Republic of China
| | - Dongliang Guo
- Department of Neurosurgery, Guangdong 999 Brain Hospital, Medical College of Jinan University, Guangzhou, Guangdong, 510000, People's Republic of China
| | - Tao Shi
- Department of Neurosurgery, Guangdong 999 Brain Hospital, Medical College of Jinan University, Guangzhou, Guangdong, 510000, People's Republic of China
| | - Ming Lu
- Department of Neurosurgery, Guangdong 999 Brain Hospital, Medical College of Jinan University, Guangzhou, Guangdong, 510000, People's Republic of China
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Zhang G, Wang J, Wang P, Wu N. Endoscopic Ipsilateral Interhemispheric Approach for Middle-Third Falcine Meningioma: A Case Report and Literature Review. Brain Sci 2023; 13:1085. [PMID: 37509015 PMCID: PMC10377495 DOI: 10.3390/brainsci13071085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 07/13/2023] [Accepted: 07/14/2023] [Indexed: 07/30/2023] Open
Abstract
Middle-third falcine meningiomas (FMs) are usually hidden deep under the eloquent cortex and abundant bridging veins, which represent the main hindrances to surgical access. The endoscopic approach has the advantages of wide visualization and free visual axis without areas of visual blindness, which allows for the resection of FMs with good visualization in a narrow space, especially in deep operations. Here, we report a case of a middle-third FM treated using the endoscopic ipsilateral interhemispheric approach. A 55-year-old female who had suffered a headache for 6 months without other remarkable symptoms was diagnosed with middle-third FM combined with imaging evaluation. According to the imaging performance and anatomical features, we scheduled the endoscopic ipsilateral interhemispheric approach to access and remove the tumor. Consequently, gross total tumor resection was achieved without surgery-related complications. After the surgery, the patient had an uneventful recovery and was discharged with no neurological deficit. During the 24-month follow-up, the patient's condition remained favorable, with no tumor recurrence. In our opinion, the endoscopic ipsilateral interhemispheric approach is a feasible surgical strategy for FMs, which deserves further exploration as a treatment option.
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Affiliation(s)
- Gang Zhang
- Department of Neurosurgery, Chongqing General Hospital, Chongqing 401147, China
- Graduate Institute, Chongqing Medical University, Chongqing 400016, China
| | - Junwei Wang
- Department of Neurosurgery, Chongqing General Hospital, Chongqing 401147, China
| | - Pan Wang
- Department of Neurosurgery, Chongqing General Hospital, Chongqing 401147, China
| | - Nan Wu
- Department of Neurosurgery, Chongqing General Hospital, Chongqing 401147, China
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Winestone JS, Baker Erdman H, Khweis M, Ben David E, Margalit N. Utility of MRI in surgical planning for parasagittal meningiomas. Acta Neurochir (Wien) 2023:10.1007/s00701-023-05589-4. [PMID: 37154914 DOI: 10.1007/s00701-023-05589-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 04/07/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Surgical resection is the standard treatment for parasagittal meningioma (PSM), but complete resection may be challenging due to superior sagittal sinus (SSS) involvement. The SSS may be partially or completely obstructed, and collateral veins are commonly present. Thus, knowing the status of the SSS in PSM cases prior to treatment is essential to a successful outcome. MRI is utilized prior to surgery in order to determine SSS status and to check for presence of collateral veins. The objective of this study is to evaluate the reliability of MRI in predicting both SSS involvement and presence of collateral veins in subsequent comparison to actual intra-operative findings, and to report on complications and outcomes. METHODS 27 patients were retrospectively analyzed for this study. A blinded radiologist reviewed all pre-operative images, noting SSS status and collateral vein presence. Intraoperative findings were obtained from hospital records to similarly categorize SSS status and collateral vein presence. RESULTS Sensitivity of the MRI to SSS status was found to be 100% and specificity was 93%. However, sensitivity and specificity of MRI to collateral vein presence was only 40% and 78.6%, respectively. Complications were experienced by 22% of patients, the majority neurologic in nature. CONCLUSION MRI accurately predicted SSS occlusion status, but was less consistent in identification of collateral veins. These findings suggest MRI should be used with caution prior to PSM resection surgery particularly with regards to the presence of collateral veins which may complicate resection.
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Affiliation(s)
- John S Winestone
- Department of Neurosurgery, Shaare Zedek Medical Center, Shmuel Bait 12, Jerusalem, Israel.
- Faculty of Medicine, Hebrew University, Shmuel Bait 12, Jerusalem, Israel.
| | - Halen Baker Erdman
- Faculty of Medicine, Hebrew University, Shmuel Bait 12, Jerusalem, Israel
| | - Musa Khweis
- Department of Neurosurgery, Shaare Zedek Medical Center, Shmuel Bait 12, Jerusalem, Israel
| | - Eliel Ben David
- Faculty of Medicine, Hebrew University, Shmuel Bait 12, Jerusalem, Israel
- Department of Neuroradiology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Nevo Margalit
- Department of Neurosurgery, Shaare Zedek Medical Center, Shmuel Bait 12, Jerusalem, Israel
- Faculty of Medicine, Hebrew University, Shmuel Bait 12, Jerusalem, Israel
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Chen WW, Wang Y, Hu YC, Zhao YL. Analysis of the common complications and recurrence-related factors of superior parasagittal sinus meningioma. Front Surg 2023; 9:1023021. [PMID: 36684270 PMCID: PMC9852056 DOI: 10.3389/fsurg.2022.1023021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 10/20/2022] [Indexed: 01/07/2023] Open
Abstract
Objectives Parasagittal meningioma resection is prone to postoperative complications and tumor recurrence because the tumor invades the superior sagittal sinus. This study aimed to clarify the incidence of perioperative complications and the recurrence of superior sagittal paranasal meningiomas and explored potential predictors in this context. Methods The study retrospectively reviewed the clinical, imaging, and follow-up data of parasagittal meningiomas among patients who underwent microsurgical resection in the authors' institution from January 2008 to December 2017. Univariate and multivariate logistic regression analyses were conducted to explore independent predictors of perioperative complications and tumor recurrence. Results A total of 212 parasagittal meningioma patients were included in this study. The incidence of perioperative complications was 23.6% (50/212), and perioperative death occurred in 6 (2.8%) patients. In univariate and multivariate logistic regression analyses of perioperative complications, peritumoral edema ≥1 cm (odds ratio [OR] 2.163, 95% confidence interval [CI] 1.057-4.428, P = 0.035) and the Sindou invasion Class V-VI(OR0.018, 95% CI 1.248-11.064, P = 0.018) were independent predictors. After an average of 83 (39-154) months of clinical follow up among the living 206 patients, 22 (10.7%) patients showed tumor recurrence. In univariate and multivariate logistic regression analyses of tumor recurrence, the Sindou invasion Class III-IV (OR 5.539, 95%CI 1.469-20.884, P = 0.011) and the Sindou invasion Class V-VI (OR 9.144, 95%CI 2.215-37.757, P = 0.002) were independent predictors. Conclusions Peritumoral edema ≥1 cm and the Sindou invasion Class V-VI were the independent predictors of perioperative complications, and the Sindou invasion Class III-IV and the Sindou invasion Class V-VI were the independent predictors of tumor recurrence. The part of the parasagittal meningioma involving the sinus wall should be actively removed to the largest degree possible to reduce the recurrence rate.
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Affiliation(s)
- Wei-Wei Chen
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China,Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yong Wang
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yang-Chun Hu
- Department of Neurosurgery, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Yuan-Li Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China,Correspondence: Yuan-Li Zhao
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Cucu AI, Turliuc MD, Costea CF, Dascălu CG, Dumitrescu GF, Sava A, Turliuc Ş, Scripcariu DV, Poeată I. Tumor recurrence in parasagittal and falcine atypical meningiomas invading the superior sagittal sinus. ROMANIAN JOURNAL OF MORPHOLOGY AND EMBRYOLOGY 2021; 61:385-395. [PMID: 33544790 PMCID: PMC7864307 DOI: 10.47162/rjme.61.2.08] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
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.
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Affiliation(s)
- Andrei Ionuţ Cucu
- Department of Ophthalmology, Department of Psychiatry, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Romania; ,
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Zahid SU, Taeeb AA, Shah J, Shah A, Qaderi S, Varney J, Aiash H, Mousavi SH. A parasagittal sinus meningioma in young female adult in Afghanistan. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Zhang N, Yang T, Hameed F, Zhang X, Yao Y, Li D, Li C, Yu S, Xu Y, Xia C, Fu X. Can safe and radical resection of all types of parasagittal meningiomas be achievable? -the introduction of a simplified surgical strategy. Neurol Res 2020; 43:259-266. [PMID: 33176620 DOI: 10.1080/01616412.2020.1847530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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.
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Affiliation(s)
- Nan Zhang
- Department of Neurosurgery, the First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, China.,Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Tao Yang
- Department of Neurosurgery, the First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, China.,Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Farrukh Hameed
- Glioma Surgery Division, Neurological Surgery Department of Huashan Hospital, Fudan University, Shanghai, China
| | - Xiang Zhang
- Department of Neurosurgery, the First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, China.,Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Yang Yao
- Department of Neurosurgery, the First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, China.,Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Dongxue Li
- Department of Neurosurgery, the First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, China.,Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Changwen Li
- Department of Neurosurgery, the First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, China.,Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Shaojie Yu
- Department of Neurosurgery, the First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, China.,Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Yong Xu
- Department of Neurosurgery, the First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, China.,Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Chengyu Xia
- Department of Neurosurgery, the First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, China.,Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
| | - Xianming Fu
- Department of Neurosurgery, the First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei, China.,Department of Neurosurgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Hefei, China
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