Meningiomas Involving the Major Dural Sinuses: Management of the Sinus Invasion

Abstract

Surgery of meningiomas involving the major dural sinuses leaves the surgeon confronted with a dilemma: leave the invasive fragment and have a higher rate of recurrence, or attempt a total removal and have the venous circulation at risk. In meningiomas with the sinus remaining patent, current tendency is resection of the tumor mass outside the sinus wall(s) with surgical coagulation or adjuvant radiosurgery on the remnant. For meningiomas with complete sinus occlusion, most authors advocate “en-bloc” removal of the invaded portion [4]. Conventional knowledge states that complete removal of the invaded sinus is little dangerous because of the development of collateral venous pathways; this however may far from being true [2, 10]. Few authors favour total gross removal and, if so, reconstruction of the venous circulation [5–7, 11, 17]. The latter attitude is our preference. Literature review of the various policies has been done in references [8, 13].