scholarly journals Pre-Operative Factors Affecting Resectability of Giant Intracranial Meningiomas

2009 ◽  
Vol 36 (5) ◽  
pp. 623-630 ◽  
Author(s):  
Alfredo Quiñones-Hinojosa ◽  
Tania Kaprealian ◽  
Kaisorn L. Chaichana ◽  
Nader Sanai ◽  
Andrew T. Parsa ◽  
...  
Keyword(s):  
San Francisco ◽  
Superior Sagittal Sinus ◽  
Perioperative Complications ◽  
Radical Resection ◽  
Intracranial Meningioma ◽  
Preoperative Embolization ◽  
Factors Affecting ◽  
Sagittal Sinus ◽  
Intracranial Meningiomas

Objective:Larger intracranial tumors require extended operating times and may be associated with increased perioperative complications. There are few reports describing the experience of resecting large meningiomas ≥5cm in a variety of locations. As a group, it remains largely unknown whether these relatively rare lesions are amenable to radical resection, and what factors influence their resectability.Methods:Sixty-seven patients undergoing surgery for a large intracranial meningioma (≥5cm in the longest dimension) between 1998 and 2004 were retrospectively reviewed. The surgeries were performed at a single institution University of California at San Francisco. Predictors of resectability were assessed via multivariate logistical regression analysis.Results:Thirty-nine (58%) patients underwent gross total resection (GTR) (Simpson grades I/II). There were no cases of perioperative mortality. At last follow-up, symptoms improved in 39 (58%) patients, remained unchanged in 20 (30%), and were aggravated in 8 (12%). In the multivariate model for all large meningiomas, age>45 years [OR(95%CI);0.127 (0.026-0.616),p=0.01] and superior sagittal sinus involvement [OR(95%CI);0.160 (0.026-0.976),p=0.05] were negative predictors of GTR, while preoperative embolization [OR(95%CI);8.087(1.719-38.044),p=0.008] was positively associated with GTR. For only supratentorial meningiomas, superior sagittal sinus involvement [OR (95%CI);0.077 (0.010-0.571),p=0.01] and preoperative embolization [OR(95%CI);10.492(1.961-56.135),p=0.006] were independently associated with GTR.Conclusions:This study evaluated a subset of large intracranial meningiomas ≥5cm. The results indicate that GTR can be achieved in the majority of cases with limited morbidity and mortality, where symptoms will likely improve and recurrences seldom occur. This study may provide useful insights for patients undergoing surgery for large intracranial meningiomas.

Meningiomas Invading the Superior Sagittal Sinus: Surgical Experience in 108 Cases

Neurosurgery ◽  
2004 ◽  
Vol 55 (6) ◽  
pp. 1263-1274 ◽  
Author(s):  
Francesco DiMeco ◽  
Khan W. Li ◽  
Cecilia Casali ◽  
Elisa Ciceri ◽  
Sergio Giombini ◽  
...  
Keyword(s):  
Superior Sagittal Sinus ◽  
Radical Resection ◽  
Complete Resection ◽  
Sagittal Sinus ◽  
Simpson Grade ◽  
Postoperative Hematoma ◽  
Lost To Follow Up ◽  
Age Range ◽  
Extreme Care

Abstract OBJECTIVE: Radical resection of meningiomas invading the superior sagittal sinus (SSS) presents several hazards. Some surgeons consider SSS invasion a contraindication for complete resection, and others advocate total resection with venous reconstruction. There is a lack of published large series to provide definitive guidelines for the surgical treatment of these complex cases. We report our 15-year experience with surgery of parasagittal meningiomas invading the SSS. METHODS: Between 1986 and 2001, 108 patients (73 women, 35 men; age range, 22–83 yr; mean age, 56.2 yr) underwent surgery at the Neurological Institute “C. Besta” of Milan for tumors invading the SSS. Parasagittal meningiomas not invading the SSS were excluded from this series. RESULTS: Simpson Grade I to II removal was achieved in 100 patients. Thirty patients with meningiomas totally occluding the SSS had complete resection of the encased portion of the sinus. Histological examination revealed 86 benign (79.6%), 16 atypical (14.8%), and 4 malignant (3.7%) meningiomas along with 2 hemangiopericytomas. There were two perioperative deaths. Serious complications included brain swelling (nine patients; 8.3%) and postoperative hematoma (two patients; 1.85%). Follow-up ranged from 19 to 223 months (mean, 79.5 mo). One patient was lost to follow-up. Tumors recurred in 15 patients (13.9%). After multivariate analysis, histological type, tumor size, and Simpson grade were confirmed as significant independent prognostic factors for recurrence. CONCLUSION: On the basis of our results, we conclude that if the sinus is partially invaded, it can be opened to obtain as complete a resection as possible and to attempt to preserve the patency of the sinus. If the sinus is obstructed, the portion of the sinus involved can be resected completely. In both situations, extreme care is vital to preservation of cortical veins, which may offer important collateral drainage. With our approach, good results are achieved and it is not necessary to reconstruct the sinus.

scholarly journals Evaluation of surgical outcome of giant intracranial meningiomas

2020 ◽  
Vol 35 (1) ◽  
Author(s):  
Ramy Teama ◽  
Mohamed Adawy ◽  
Mohamed Emara
Keyword(s):  
Surgical Outcome ◽  
Intraoperative Complications ◽  
Intracranial Meningioma ◽  
Surgical Removal ◽  
Study Group ◽  
Main Body ◽  
Total Removal ◽  
Large Size ◽  
Intracranial Meningiomas

Abstract Background The surgery of giant intracranial meningiomas (GIM) is difficult due to its large size, prominent vascularity, including and limiting visualization of various neurovascular structures, and severe cerebral edema. In this study, we will evaluate the surgical outcome of giant meningiomas according to our experience at our hospital in management of giant intracranial meningioma. Main body A retrospective analysis of 48 patients with histologically proven meningioma (≥ 6-cm diameter) who underwent surgical treatment at Benha University hospitals over a period of 5 years (June 2014/June 2019) is presented. Details regarding clinical presentation, imaging findings, surgical results and complications, and follow-up status were collected. The study group was composed of 41 females and 7 males. The age of the study group ranged from 38 to 69 years with an average of 49 years. The mean follow-up period was 36 months. Different approaches were used according to tumor location with the aim of gross total removal. Gross total removal was achieved in 90% of cases (43 cases). There were 2 cases with intraoperative complications not related to surgery. Recurrence was present in 4 cases. Mortality in this series was 4% (2 cases) with no reported intraoperative mortality. Conclusion Management of giant intracranial meningioma is a relatively common practice in neurosurgical centers in developing countries with the aim of radical total surgical removal being the first and most optimum option. Large size makes surgery difficult, but young age, meticulous surgical techniques, proper localization, trying to minimize operative time, and Simpson grade are of special value. Interdisciplinary cooperation is essential to avoid the common complications like pulmonary embolism (PE), postoperative hematoma in tumor bed that leads to bad surgical outcome.

Lateral Ventricle to Sylvian Fissure Shunt for Obstructive Hydrocephalus: First Report

2017 ◽  
Vol 78 (05) ◽  
pp. 513-516
Author(s):  
Sushil Patkar
Keyword(s):  
Lateral Ventricle ◽  
Fourth Ventricle ◽  
Superior Sagittal Sinus ◽  
Obstructive Hydrocephalus ◽  
Shunt Operation ◽  
Ventriculoatrial Shunt ◽  
Sagittal Sinus ◽  
Suprasellar Cistern ◽  
Sylvian Cistern

AbstractCerebrospinal fluid (CSF) pathway studies have revealed that the CSF secreted from the choroid plexus of the ventricles after egressing from the fourth ventricle reaches the basal suprasellar cistern and ultimately the sylvian cisterns. From the sylvian cistern, the CSF travels over the cerebral convexity subarachnoid space to reach the superior sagittal sinus and enters the bloodstream. Diverting CSF from the lateral ventricle with a shunt catheter to the sylvian cistern can be an option to treat obstructive hydrocephalus. An adult patient with posttraumatic hydrocephalus with contraindications to ventriculoperitoneal and ventriculoatrial shunt placement underwent this procedure of diverting CSF from the lateral ventricle to the sylvian cistern successfully, and he had immediate relief of symptoms of raised intracranial pressure. Although preliminary results seem logical and promising, more cases and longer follow-up is required to consider this shunt operation an option in the treatment of obstructive hydrocephalus.

scholarly journals Hyperthyroidism as a Precipitant Factor for Cerebral Venous Thrombosis: A Case Report

2020 ◽  
Vol 8 ◽  
pp. 232470962094930
Author(s):  
Ahmed Elkhalifa Elawad Elhassan ◽  
Mohammed Omer Khalil Ali ◽  
Amina Bougaila ◽  
Mohammed Abdelhady ◽  
Hassan Abuzaid
Keyword(s):  
Case Report ◽  
Superior Sagittal Sinus ◽  
Sinus Thrombosis ◽  
Cerebral Venous Sinus Thrombosis ◽  
Laboratory Findings ◽  
Sagittal Sinus ◽  
History Of ◽  
Sagittal Sinus Thrombosis ◽  
Superior Sagittal Sinus Thrombosis

Cerebral venous sinus thrombosis (CVT) is an uncommon yet serious condition. While CVT has many known precipitants and etiologies, hyperthyroidism as a precipitant of CVT is not well understood. This study reported a case of a 41-year-old male with a 4-year history of hyperthyroidism presented with seizure. Consequently, a diagnosis of superior sagittal sinus thrombosis was confirmed by computed tomography and magnetic resonance (MR) venograms. Extensive investigations yielded no apparent underlying cause, but laboratory findings were consistent with uncontrolled hyperthyroidism. The patient improved rapidly following anticoagulation. Follow-up MR and MRV scans 2 months after treatment revealed full recanalization of the superior sagittal sinus. This case report highlighted hyperthyroidism, as a procoagulant condition, resulting specifically in superior sagittal sinus thrombosis.

A pilot study and novel angiographic classification for superior sagittal sinus stenting in patients with non-thrombotic intracranial venous occlusive disease

2017 ◽  
Vol 10 (1) ◽  
pp. 74-77 ◽  
Author(s):  
Daniel M S Raper ◽  
Thomas J Buell ◽  
Dale Ding ◽  
I Jonathan Pomeraniec ◽  
R Webster Crowley ◽  
...  
Keyword(s):  
Clinical Symptoms ◽  
Superior Sagittal Sinus ◽  
Venous Pressure ◽  
Transverse Sinus ◽  
Occlusive Disease ◽  
Pressure Gradients ◽  
Frontal Pole ◽  
Sagittal Sinus

ObjectiveSafety and efficacy of superior sagittal sinus (SSS) stenting for non-thrombotic intracranial venous occlusive disease (VOD) is unknown. The aim of this retrospective cohort study is to evaluate outcomes after SSS stenting.MethodsWe evaluated an institutional database to identify patients who underwent SSS stenting. Radiographic and clinical outcomes were analyzed and a novel angiographic classification of the SSS was proposed.ResultsWe identified 19 patients; 42% developed SSS stenosis after transverse sinus stenting. Pre-stent maximum mean venous pressure (MVP) in the SSS of 16.2 mm Hg decreased to 13.1 mm Hg after stenting (p=0.037). Preoperative trans-stenosis pressure gradient of 4.2 mm Hg decreased to 1.5 mm Hg after stenting (p<0.001). No intraprocedural complication or junctional SSS stenosis distal to the stent construct was noted. Improvement in headache, tinnitus, and visual obscurations was reported by 66.7%, 63.6%, and 50% of affected patients, respectively, at mean follow-up of 5.2 months. We divided the SSS into four anatomically equal segments, numbered S1–S4, from the torcula to frontal pole. SSS stenosis typically occurs in the S1 segment, and the anterior extent of SSS stents was deployed at the S1–S2 junction in all but one case.ConclusionsSSS stenting is reasonably safe, may improve clinical symptoms, and significantly reduces maximum MVP and trans-stenosis pressure gradients in patients with VOD with SSS stenosis. The S1 segment is most commonly stenotic, and minimum pressure gradients for symptomatic SSS stenosis may be lower than for transverse or sigmoid stenosis. Additional studies and follow-up are necessary to better elucidate appropriate clinical indications and long-term efficacy of SSS stenting.

Preoperative Embolization of Intracranial Meningiomas

Neurosurgery ◽  
1983 ◽  
Vol 13 (3) ◽  
pp. 261-268 ◽  
Author(s):  
Hans-Peter Richter ◽  
Walter Schachenmayr
Keyword(s):  
Carotid Artery ◽  
Histopathological Examination ◽  
External Carotid Artery ◽  
External Carotid ◽  
Intracranial Meningioma ◽  
Preoperative Embolization ◽  
Computed Tomographic ◽  
Intracranial Meningiomas ◽  
Feeding Vessels ◽  
Lyophilized Dura Mater

Abstract The operative and histopathological findings in 31 cases of intracranial meningioma after preoperative embolization with Gelfoam and/or lyophilized dura mater are reported. Removal of the tumor after embolization was facilitated in those meningiomas fed exclusively or mainly by branches of the external carotid artery (29 of 31). Large areas of tumor necrosis were never seen on histopathological examination, even when suggested by large regions of decreased density on the postembolization computed tomographic scan. Preoperative embolization of the feeding vessels arising from the external carotid artery system has proven to be a useful adjunct before the resection of intracranial meningiomas.

scholarly journals Cerebral Venous Air Embolism due to a Hidden Skull Fracture Secondary to Head Trauma

2015 ◽  
Vol 2015 ◽  
pp. 1-3
Author(s):  
Ai Hosaka ◽  
Tetsuto Yamaguchi ◽  
Fumiko Yamamoto ◽  
Yasuro Shibagaki
Keyword(s):  
Head Trauma ◽  
Superior Sagittal Sinus ◽  
Skull Fracture ◽  
Air Embolism ◽  
Skull Fractures ◽  
Venous Air Embolism ◽  
Sagittal Sinus ◽  
The Right ◽  
Head Computed Tomography

Cerebral venous air embolism is sometimes caused by head trauma. One of the paths of air entry is considered a skull fracture. We report a case of cerebral venous air embolism following head trauma. The patient was a 55-year-old man who fell and hit his head. A head computed tomography (CT) scan showed the air in the superior sagittal sinus; however, no skull fractures were detected. Follow-up CT revealed a fracture line in the right temporal bone. Cerebral venous air embolism following head trauma might have occult skull fractures even if CT could not show the skull fractures.

scholarly journals P.062 Does the intensity of brain parenchymal contrast staining on post-recanalization dual energy head CT (DECT) of stroke patients predict the fate of brain tissue?

2021 ◽  
Vol 48 (s3) ◽  
pp. S36-S36
Author(s):  
B Alomran ◽  
D Byrne ◽  
J Walsh ◽  
N Murray ◽  
F Settecase ◽  
...  
Keyword(s):  
Superior Sagittal Sinus ◽  
Iodine Concentration ◽  
Hemorrhagic Transformation ◽  
Brain Parenchyma ◽  
Anterior Circulation ◽  
Head Ct ◽  
Sagittal Sinus ◽  
Endovascular Recanalization ◽  
Brain Parenchymal

Background: On DECT, the ratio of maximum iodine concentration within parenchyma compared to the superior sagittal sinus has been shown to predict hemorrhagic transformation. We aimed to determine if this ratio also predicts the development of an infarct. Methods: 53 patients with small infarct cores (ASPECTS≥7) and good endovascular recanalization (mTICI 2b/3) were enrolled. Maximum brain parenchymal iodine concentration as per DECT relative to the superior sagittal sinus (iodine ratio) was correlated with the development of an infarct on follow up CT. Results: All patients showed contrast staining, 52 developed infarcts in the area of staining. The extent of infarction (smaller, equal or larger than area of staining) did not correlate with the iodine ratio. Conclusions: Brain parenchyma with contrast staining on post-procedure head CT almost invariably goes on to infarct, however the extent of infarct development is not predicted by the intensity of contrast staining. n=53 patients with successful recanalization of anterior circulation LVO infarct (TICI2b,3) with post procedural parenchymal iodine staining There was no correlation between the degree of contrast staining on initial post procedural CT as expressed in iodine ratio and F/U infarct extent.

scholarly journals Treatment and prognosis of pleuropulmonary blastoma: A Single-Center Report of 31 Cases

2021 ◽  
Author(s):  
Feng Wang ◽  
Lin Zhuang ◽  
Jianghua Liang ◽  
Le Li ◽  
Hui Wang ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Progression Free Survival ◽  
Patient Characteristics ◽  
Radical Resection ◽  
Treatment Modalities ◽  
Rank Test ◽  
Pleuropulmonary Blastoma ◽  
Free Survival ◽  
Factors Affecting

Objectives: Pleuropulmonary blastoma (PPB) is a very rare, characteristic and highly aggressive neoplasm occurring in children, most under 6 years of age. We assessed the clinical characteristics, treatment modalities, treatment outcomes, and prognostic factors affecting survival in patients with PPB treated at our institution over a 10-year period to improve the prognosis of PPB. Methods: From November 2008 to November 2019, 31 children (21 boys and 10 girls) with a median age of 30 months (range, 22 days-54 months) were treated at our institution. Here, we describe the patient characteristics, treatment modalities and treatment outcomes. The Kaplan-Meier method was used to estimate the progression free survival probability (PFS) and overall survival (OS). Log-rank test was performed for comparison between groups. Results: 3 children were lost to follow-up and 2 were dead of postoperative complications. Of the 26 patients included in the follow-up, 16 PPB patients displayed tumor-free survival. The 6-month, 1-, 3-, and 5-year PFS were 80.8%, 69.0%, 60.4% and 60.4%, respectively. Accordingly, the 6-month, 1-, 3-, and 5-year OS were 84.6%, 72.7%, 60.1% and 60.1%, respectively. Sex, extent of surgery and chemotherapy/irradiation appeared to affect the survival, while age and pathology type appeared not to do. Conclusions: PPB is an aggressive neoplasm. To improve the prognosis of PPB, we should promote radical resection and improve the auxiliary treatment measures.

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