Venous reconstruction in surgery of meningiomas invading the sagittal and transverse sinuses

Surgery of meningiomas involving major dural sinuses leaves the surgeon con fronted with a difficult dilemma: leave the fragment invading the sinus in place and have a higher risk of recurrence, or attempt a total removal with or without venous reconstruction and expose the patient to a potentially g reater operative danger. The authors report a Series of 47 meningiomas (41 of the sagittal sinus, 4 of the transverse sinus and 2 of the torcular) in whom gross total removal was achieved in all cases, and venous reconstructi on (of various types) attempted in a majority. Thirty-nine patients had a g ood outcome and resumed their previous activities. There was a permanent ne urological deficit in five due to infarction secondary to injury of central veins (all in the sagittal sinus midthird). Three patients died from brain swelling; all with meningioma totally occluding the sinus and in whom rese ction was achieved without sinus reconstruction. There were two recurrences in this series which has a mean follow-up of 7.5 years. The authors' surgical experience led them to favor whenever possible, total removal with sinus reconstruction, using a patch for meningiomas with part ial sinus: invasion and a venous bypass for those with total sinus occlusio n.