Parasagittal Meningiomas: The Impact of Sinus Opening and Grade of Resection on Clinical Outcome and Recurrence in a Consecutive Series of Patients

Giandomenico Petrella; Amedeo Piazza; Arianna Fava; Nicola Gorgoglione; Michelangelo De Angelis; Tommaso Vangelista; Riccardo Morganti; Paolo di Russo; Vincenzo Esposito

doi:10.1016/j.wneu.2024.04.030

Parasagittal Meningiomas: The Impact of Sinus Opening and Grade of Resection on Clinical Outcome and Recurrence in a Consecutive Series of Patients

World Neurosurg. 2024 Apr 10:S1878-8750(24)00593-X. doi: 10.1016/j.wneu.2024.04.030. Online ahead of print.

Authors

Giandomenico Petrella¹, Amedeo Piazza², Arianna Fava³, Nicola Gorgoglione⁴, Michelangelo De Angelis⁴, Tommaso Vangelista⁴, Riccardo Morganti⁵, Paolo di Russo⁶, Vincenzo Esposito³

Affiliations

¹ Department of Neurosurgery, I.R.C.C.S. Neuromed, Pozzilli, Italy; Department of Neurosurgery, Policlinico di Bari, Bari, Italy.
² Department of Neurosurgery, I.R.C.C.S. Neuromed, Pozzilli, Italy; University of Rome, Rome, Italy; Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy.
³ Department of Neurosurgery, I.R.C.C.S. Neuromed, Pozzilli, Italy; University of Rome, Rome, Italy.
⁴ Department of Neurosurgery, I.R.C.C.S. Neuromed, Pozzilli, Italy.
⁵ Department of Clinical and Experimental Medicine, Section of Statistics, University of Pisa, Pisa, Italy.
⁶ Department of Neurosurgery, I.R.C.C.S. Neuromed, Pozzilli, Italy. Electronic address: p.dirusso.nch@gmail.com.

PMID: 38608810
DOI: 10.1016/j.wneu.2024.04.030

Abstract

Background: Surgical management of parasagittal meningiomas (PMs) remains controversial in the literature. The need to pursue a resection as radical as possible and the high risk of venous injuries contribute to making the sinus opening a widely argued choice. This study aimed to analyze factors affecting the risk of recurrence and to assess clinical outcomes of patients who underwent surgical resection of PMs with conservative or aggressive management of the intrasinusal portion.

Methods: A single-institution retrospective review of all patients with PM surgically treated between January 2013 and March 2021 was conducted.

Results: Among 56 patients, the sinus was opened in 32 patients (57%), and a conservative approach was used in 24 patients (43%). The sinus opening was found to be a predictive factor of radical resection (Simpson grade [SG] I-II) (P = 0.007). SG was the only predictive factor of recurrence (P < 0.001). The radical resection group (SG I-II) showed recurrence-free survival at 72 months of about 90% versus 30% in the non-radical resection group (SG III-IV) (log-rank test = 14.21, P < 0.001). Aggressive management of the sinus and radical resection were not found to be related to permanent deficit (P = 0.214 and P = 0.254) or worsening of Karnofsky performance scale score (P = 0.822 and P = 0.933).

Conclusions: Removal of the intrasinusal portion of the tumor using standard procedures is not associated with a higher risk of permanent deficit or worsening of Karnofsky performance scale and reduces the risk of recurrence.

Keywords: Parasagittal meningioma; SSS management; Simpson grade; Sinus occlusion.