Abstract
Background
The surgical resection of the middle third parasagittal meningioma (PSM) is difficult, where the challenge is to systematically protect the eloquent parenchyma and collateral venous drainage.
Method
We report a case of PSM that eroded the skull, wholly occluded the superior sagittal sinus at the middle third segment, underwent radical resection with evaluation and preservation of the collateral venous drainage by preoperative venography, and intraoperative indocyanine green videoangiography (ICGVA) that aimed to avoid postoperative complications.
Conclusion
This case demonstrates the importance of venous preservation strategy and the value of ICGVA in the intraoperative assessment of collateral venous drainage function.
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References
Aboud E, Tamer WA, Ibn Essayed W, Al-Mefty O (2021) Resection of giant invasive parasagittal atypical meningioma with a venous graft reconstruction of the sagittal sinus: 2-dimensional operative video. Oper Neurosurg (Hagerstown) 21:E332–E333
Bonnal J, Brotchi J (1978) Surgery of the superior sagittal sinus in parasagittal meningiomas. J Neurosurg 48:935–945
d’Avella E, Volpin F, Manara R, Scienza R, Della Puppa A (2013) Indocyanine green videoangiography (ICGV)-guided surgery of parasagittal meningiomas occluding the superior sagittal sinus (SSS). Acta Neurochir (Wien) 155:415–420
Eichberg DG, Casabella AM, Menaker SA, Shah AH, Komotar RJ (2020) Parasagittal and parafalcine meningiomas: integral strategy for optimizing safety and retrospective review of a single surgeon series. Br J Neurosurg 34:559–564
Ferroli P, Nakaji P, Acerbi F, Albanese E, Broggi G (2011) Indocyanine green (ICG) temporary clipping test to assess collateral circulation before venous sacrifice. World Neurosurg 75:122–125
Georgoulis G, Sindou M (2017) Parasagittal meningioma (posterior third) occluding the superior sagittal sinus: complete resection and venous repair: 3-dimensional operative video. Oper Neurosurg (Hagerstown) 13:283–284
Hoessly GF, Olivecrona H (1955) Report on 280 cases of verified parasagittal meningioma. J Neurosurg 12:614–626
Ko CC, Chen TY, Lim SW, Kuo YT, Wu TC, Chen JH (2019) Prediction of recurrence in parasagittal and parafalcine meningiomas: added value of diffusion-weighted magnetic resonance imaging. World Neurosurg 124:e470–e479
Magill ST, Theodosopoulos PV, McDermott MW (2016) Resection of falx and parasagittal meningioma: complication avoidance. J Neurooncol 130:253–262
Yu G, Wang X, Zhang X, Quan K, Hua W, Yang Z, Li P, Liu P, Song J, Zhu W (2020) Gravity-assisted ipsilateral paramedian approach for parafalcine meningioma resection. World Neurosurg 135:234–240
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Ethics approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by Huashan Hospital Institutional Review Board (HIRB), Fudan University, Shanghai, China.
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It represents a video of a surgical case. The patient gave approval for this publication.
Conflict of interest
The authors declare no competing interests.
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Key points
1. The clinical prognosis of the PSM, including long- and short-term recurrence, morbidity, and cortical function, is related to the extent of resection and proper management of venous drainage.
2. It is challenging to systematically protect the eloquent parenchyma and collateral venous drainage during the middle third PSM resection.
3. Preoperative MRV or CTV is necessary for SSS obstruction evaluation and surgical plan assessment.
4. SSS reconstruction is recommended for unobstructed SSS or selected obstructed SSS of the middle and posterior segment.
5. When the middle third SSS is occluded, preservation of the collateral venous drainage becomes paramount.
6. The veinous structure is not bulging and can be easily dissected sharply when adequate brain relaxation is achieved.
7. For the middle third PSM, a timing surgery aiming to preserve sensorimotor function is feasible with no prominent edema or symptoms preoperatively.
8. ICGVA is a useful supplementary intraoperative tool for sinus and vessel visualization and cortical perfusion evaluation before and after SSS ligation.
9. A slack brain with a fast flashing of the ICGVA dye through the bridging vein indicates a well-preserved venous drainage function, and hemostasis is very easy to achieve under this condition.
10. Considering the high surgical risk of the middle third PSM, the patient should be fully informed about the risks and benefits.
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This article is part of the Topical Collection on Brain Tumors
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Supplementary file1 This video illustrates a surgical resection of a middle third PSM with a venous preservation strategy (MP4 109624 KB)
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Wang, H., Yang, Z., You, H. et al. How I do it: the surgical resection of a middle third parasagittal meningioma with venous preservation strategy. Acta Neurochir 164, 1385–1389 (2022). https://doi.org/10.1007/s00701-022-05129-6
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DOI: https://doi.org/10.1007/s00701-022-05129-6