Spontaneous peritumoral haemorrhage associated with sinus confluence meningioma: Case report

BACKGROUND Torcular or sinus confluence meningioma is rare and surgically formidable. This reported sinus confluence meningioma was associated with peritumoral i ntracerebral hemorrhage. The surgical strategy and the mechanism of peritum oral hemorrhage are discussed. CASE DESCRIPTION A 42-year-old woman presented with a history of headache, vomiting, and cer ebellar dysfunction for 2 months. Plain computed tomography (CT) scan and m agnetic resonance imaging (MRI) demonstrated a high-density mass in the tor cular region involving both lateral sinuses. MR angiography demonstrated co mplete occlusion of the left lateral sinus and straight sinus and stenosis of the right lateral sinus. Two years after her first operation she experie nced sudden headache and left upper quadrant hemianopsia. plain CT scan and MRI showed a hyperintense tumor in the torcular region with an intracerebr al hematoma in the right occipital lobe. An angiogram demonstrated occlusio n of the caudal part of the superior sagittal sinus, bilateral transverse s inuses, and straight sinus. Gross total removal of the tumor was done along with the left lateral sinus through a suboccipital and a supratentorial occipital craniotomy in the fi rst operation. The patient underwent total resection of the tumor at second operation through a bilateral occipital and suboccipital craniotomy along with resection of the dura including the confluence, the caudal part of the superior sagittal sinus, the right lateral sinus, and the straight sinus. The postoperative course was uneventful and postoperative MRI showed total removal of the tumor. CONCLUSION Sinus confluence meningioma may present with peritumoral hemorrhage. Radica l removal may be possible when the sinus confluence is completely occluded and there is good collateral drainage. (C) 2000 by Elsevier Science Inc.