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| Name | Parasagittal Meningioma Occluding the Superior Sagittal Sinus |
| Video Uploader | Video From NEUROSURGERY Journal |
| Upload Date | This Video Uploaded At 27-02-2018 17:05:04 |
| Video Discription | Meningiomas invading the Superior Sagittal Sinus (SSS) bring a challenging dilemma: Leave the invasive fragment and have higher recurrence, or attempt total removal including the intrasinusal fragment and put venous circulation to risk. Because the patient suffered from intracranial hypertension (headaches, papilledema, visual deterioration) attributed to deficiency in venous return due to (left) parasagittal meningioma invading and subtotally occluding the posterior third of SSS, total resection of tumor and restoration of venous circulation was decided. Craniotomy crossed midline to visualize both sides of the sinus, and extended outside the margins of the invaded portion for proximal and distal control. The extrasinusal portion was resected first, taking care to respect the afferent veins (generally few in posterior third). Then, under temporary clamping (25 minutes duration), the intrasinusal fragment was removed. In this Type-V meningioma (with contralateral wall not-invaded by definition), venous reconstruction was performed using a patch, harvested from fascia-temporalis, with two hemirunning sutures. After clamp removal, patency was checked with Doppler-microprobe. According to our experience [Sindou MP, Alvernia JE J Neurosurg 2006, 105:514-525], Anticoagulation (heparin), started at curative doses next morning for one month; then was replaced by antiplatelets for three months, until endothelization of the graft. After uneventful postoperative period, imaging at three months showed meningioma resection and SSS patency. Symptoms of intracranial hypertension had disappeared. In conclusion, Type-V meningioma with subtotal lumen occlusion, but at least the contralateral wall of the SSS not-invaded, can be resected with simultaneous venous circulation restoration. |
| Category | Science & Technology |
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