To the content
4 . 2021

Bypass surgery of the superior sagittal sinus using an insertion graft for the removal of parasagittal meningioma of the middle third of the sickle of the brain: clinical observation and literature review

Abstract

Background. Brain meningiomas are one of the most common benign brain tumors. When a brain sinus tumor is invaded, a careful choice of treatment tactics is necessary. The choice of radical intervention in these patients is a complex problem.

The aim of the study is to present our own clinical observation of radical removal of meningioma invading the upper sagittal sinus with its bypass surgery and a review of the literature on this issue. 

Material and methods. The article presents clinical case of 44-year old patient with parasagittal atypical meningioma of medial third of falx, Grade II, which occluded superior sagittal sinus, type VI, Krause. Patient undergone microsurgical resection of meningioma with subsequent superior sagittal sinus revascularization using an interposition graft from radial artery. We present a brief literature review, dedicated to reconstructive surgery of brain sinuses and veins.

Results. As a result of surgical intervention, the anaplastic meningioma was radically removed and the upper sagittal sinus was shunted using an insert graft. 6-month follow-up of the patient shows no relapse and neurological deficits at the preoperative level.

Conclusion. There are a number of issues that must be resolved for successful venous system reconstruction operations: indications for revascularization, graft selection, use of a temporary shunt, stopping bleeding at the time of anastomosis formation, checking the shunt's viability.

Keywords:superior sagittal sinus revascularization, superior sagittal sinus occlusion, falx meningioma, revascularization of the venous system

Funding. The study had no sponsor support.
Conflict of interest. The authors declare no conflict of interest.
For citation: Krylov V.V., Polunina N.A., Trifonov I.S., Staroverov M.S., Orlov E.A., Sedova D.D., Sinkin M.V., Nosova A.G. Bypass surgery of the superior sagittal sinus using an insertion graft for the removal of parasagittal meningioma of the middle third of the sickle of the brain: clinical observation and literature review. Clinical and Experimental Surgery. Petrovsky Journal. 2021; 9 (4): 131-7. DOI: https://doi.org/10.33029/2308-1198-2021-9-4-131-137 (in Russian)

References

1.    Lukyanchikov V.A., Staroverov M.S. Revascularization of the brain according to the Bonnet technique. Neyrokhirurgiya [Neurosurgery]. 2019; (21): 85-93. URL: https://www.therjn.com/jour/article/view/723 (in Russian)

2.    Lukyanchikov V.A., et al. Disabling a giant fusiform aneurysm of the pericallosa artery using a hemi-bonnet bypass. Case study and literature review. Voprosy neirokhirur-gii imeni N.N. Burdenko [Problems of Neurosurgery named after N.N. Burdenko]. 2020; (84): 88-95. (in Russian)

3.    Adachi K., Hasegawa M., Hirose Y. Evaluation of venous drainage patterns for skull base meningioma surgery. Neurol Med Chir (Tokyo). 2017; 57: 505-12.

4.    Schmid-Elsaesser R., Steiger H.-J., Yousry T., See-los K.C., Reulen H.-J. Radical resection of meningiomas and arteriovenous fistulas involving critical dural sinus segments: experience with intraoperative sinus pressure monitoring and elective sinus reconstruction in 10 patients. Neurosurgery. 1997; 41: 1005-17.

5.    Sindou M.P., Alvernia J.E. Results of attempted radical tumor removal and venous repair in 100 consecutive meningiomas involving the major dural sinuses. J Neurosurg. 2006; 105: 514-25.

6.    Sheng H.-S., et al. Traumatic open depressed cranial fracture causing occlusion of posterior superior sagittal sinus: case report. Medicine (Baltimore). 2017; 96: e7055.

7.    George B., Sainte-Rose C., Sindou M., Hitchcock E.R. Lateral sinus reconstructive surgery: treatment of intracranial hypertension by venous anastomosis. Neurol Res. 1984; 6: 203-6.

8.    Fang Q., Jiang A., Tao W., Xin L. Anatomic comparison of veins of Labbe between autopsy, digital subtraction angiography and computed tomographic venography. Biomed Eng Online. 2017; 16: 84.

9.    Sekhar L.N., Tzortzidis F.N., Bejjani G.K., Sches-sel D.A. Saphenous vein graft bypass of the sigmoid sinus and jugular bulb during the removal of glomus jugulare tumors. J Neurosurg. 1997; 86: 1036-41.

10.    Wang S., Ying J., Wei L., Li S., Jing J. Effects of parasagittal meningiomas on intracranial venous circulation assessed by the virtual reality technology. Int J Clin Exp Med. 2015; 8: 12 706-15.

11.    Sindou M. Meningiomas invading the sagittal or transverse sinuses, resection with venous reconstruction. J Clin Neurosci. 2001; 8: 8-11.

12.    Sindou M., Mazoyer J.-F., Fischer G., Pialat J., Fourcade C. Experimental bypass for sagittal sinus repair. J Neurosurg. 1976; 44: 325-30.

13.    Ricci A., et al. Parasagittal meningiomas: our surgical experience and the reconstruction technique of the superior sagittal sinus. Surg Neurol Int. 2017; 8: 1.

14.    Hakuba A., Huh C.W., Tsujikawa S., Nishimura S. Total removal of a parasagittal meningioma of the posterior third of the sagittal sinus and its repair by autogenous vein graft. J Neurosurg. 1979; 51: 379-82.

15.    Sindou M., Hallacq P. Venous reconstruction in surgery of meningiomas invading the sagittal and transverse sinuses. Skull Base. 1998; 8: 57-64.

All articles in our journal are distributed under the Creative Commons Attribution 4.0 International License (CC BY 4.0 license)

CHIEF EDITOR
CHIEF EDITOR
Sergey L. Dzemeshkevich
MD, Professor (Moscow, Russia)

Journals of «GEOTAR-Media»