Management of Parasagittal Meningiomas

Parasagittal region is considered to be the second most common origin of meningioma. They are challenging lesions, may invade the superior sagittal sinus (SSS), and/or encase/adhere to the bridge cerebral veins (Surgery of the intracranial venous system. Tokyo: Springer-Verlag, p. 207–19, 1986; J Neurosurg 119:74–81, 2013). Total microsurgical resection remains a challenge in terms of the postoperative neurological status of the patient. It is a surgery which starts from a thorough patient positioning and which requires a careful dissection and manipulation of venous structures. The use of MRV and the ICGV play a valuable role in the preservation of collateral veins.(Acta Neurochir (Wien) 165(7):1717–1725, 2023). Despite the identification with indocyanine green video angiography, patients are still at risk of delayed cerebral venous infarction during the week following surgery (Br J Neurosurg 36(6):756–61, 2022). Bonnal and Sindou’s classifications allow to establish an appropriate scheme during surgery (J Neurosurg 48:935–45, 1978; J Neurosurg. 2006;105:514–25). Intraoperative neurophysiological monitoring whenever available (EEG, VEPs, SSEPs, MEPs) facilitates the success of the surgery (Surg Neurol Int 8:1, 2017; Neurosurg Rev 45(2):1481–1490, 2022). Surgery of parasagital meningiomas is the first option in the majority of cases, but in some cases, adjuvant therapy with radiotherapy may be contemplated (J Neuro-Oncol 160: 1–11, 2022). © The Author(s), under exclusive license to Springer Nature Switzerland AG 2024.