Meningiomas occluding the superior sagittal sinus： venous collateral circulation and surgical techniques

doi:10.3877/cma.j.issn.2095-123X.2025.01.012

Abstract

Abstract:

Meningiomas occluding the superior sagittal sinus （SSS） present a significant surgical challenge. Given the intricate relationship between tumor tissue and venous structures， there is no consensus on the optimal surgical approach. Depending on the origin of the tumor， meningiomas associated with the SSS can be classified into two types： type Ⅰ （parasagittal meningiomas） and type Ⅱ（sagittal sinus meningiomas）. Both types exhibit distinct imaging characteristics and require different surgical strategies. Preoperative evaluation of the venous collateral circulation surrounding the tumor is essential to assess venous compensatory capacity and guide intraoperative decision-making. This video focuses on maximizing tumor resection while preserving venous integrity.

Key words: Meningioma, Superior sagittal sinus, Venous collateral circulation, Surgical strategy

Shousen Wang, Tengkun Yin. Meningiomas occluding the superior sagittal sinus： venous collateral circulation and surgical techniques[J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2025, 15(01): 61-64.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhnkjbykfzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-123X.2025.01.012

https://zhnkjbykfzz.cma-cmc.com.cn/EN/Y2025/V15/I01/61

Figures/Tables 1

References 15

［1］	Wang S， Ying J， Wei L， et al. Guidance value of intracranial venous circulation evaluation to parasagittal meningioma operation［J］. Int J Clin Exp Med， 2015， 8（8）： 13508-13515.
［2］	Yin T， Lin K， Wang J， et al. Letter： advances in the understanding of meningiomas involving the superior sagittal sinuses［J］.Neurosurgery， 2020， 87（1）： E74-E76. DOI： 10.1093/neuros/nyaa 087.
［3］	Tomasello F， Conti A， Cardali S， et al. Venous preservationguided resection： a changing paradigm in parasagittal meningioma surgery［J］. J Neurosurg， 2013， 119（1）： 74-81. DOI： 10.3171/2012.11.JNS112011.
［4］	Giordan E， Sorenson TJ， Lanzino G. Optimal surgical strategy for meningiomas involving the superior sagittal sinus： a systematic review［J］. Neurosurg Rev， 2020， 43（2）： 525-535. DOI： 10.1007/s10143-018-1026-1.
［5］	应建彬，李克磊，王守森. 上矢状窦内起源脑膜瘤的影像解剖依据［J］. 中国临床解剖学杂志， 2020， 38（5）： 500-505. DOI：10.13418/j.issn.1001-165x.2020.05.002.Ying JB， Li KL， Wang SS. The imaging anatomical basis of meningioma in the superior sagittal sinus［J］. Chin J Clin Anatomy，2020， 38（5）： 500-505. DOI： 10.13418/j.issn.1001-165x.2020.05.002.
［6］	Bonnal J， Brotchi J. Surgery of the superior sagittal sinus in parasagittal meningiomas［J］. Neurosurg， 1978， 48（6）： 935-945.DOI： 10.3171/jns.1978.48.6.0935.
［7］	Sindou M， Auque J. The intracranial venous system as a neurosurgeon's perspective［J］. Ady Tech Stand Neurosurg， 2000，26： 131-216. DOI： 10.1007/978-3-7091-6323-8_5.
［8］	Antunes A， Winter R. Parasagittal meningiomas： prognostic factors for recurrence［J］. Adv Tech Stand Neurosurg， 2023， 48：277-289. DOI： 10.1007/978-3-031-36785-4_10.
［9］	Wang S， Ying J， Wei L， et al. Effects of parasagittal meningiomas on intracranial venous circulation assessed by the virtual reality technology［J］. Int J Clin Exp Med， 2015， 8（8）：12706-12715.
［10］	尹腾昆，顾建军，黄银兴，等. 颅内3D静脉融合模型的建立及其在脑膜瘤切除术中的应用［J］. 中华神经医学杂志， 2017， 16（3）： 285-290. DOI： 10.3760/cma.j.issn.1671-8925.2017.03.013.Yin TK， Gu JJ， Huang YX， et al. Establishment of 3D venousfusion models and their application in meningioma operations［J］.Chin J Neuromed， 2017， 16（3）： 285-290. DOI： 10.3760/cma.j.issn.1671-8925.2017.03.013.
［11］	Yin T， Gu J， Huang Y， et al. Assessment and treatment of peritumoral cortical veins in parasagittal meningiomas with application of 3-Dimensional imaging fusion model［J］. World Neurosurg， 2017， 104： 220-228. DOI： 10.1016/j.wneu.2017.04.145.
［12］	Yin T， Zhang J， Zhang H， et al. Poor brain-tumor interface-related edema generation and cerebral venous decompensation in parasagittal meningiomas［J］. World Neurosurg， 2018， 115： e544-e551. DOI： 10.1016/j.wneu.2018.04.092.
［13］	王守森，尹腾昆. 颅内静脉解剖与循环障碍的再认识［J］. 中国临床解剖学杂志， 2020， 38（5）： 497-499. DOI： 10.13418/j.issn.1001-165x.2020.05.001.Wang SS， Yin TK. Advances in the understanding of intracranial venous anatomy and its circulatory disturbance［J］. Chin J Clin Anatomy， 2020， 38（5）： 497-499. DOI： 10.13418/j.issn.1001-165x.2020.05.001.
［14］	尹腾昆，王守森. 上矢状窦旁脑膜瘤患者镰状窦的MRV研究［J］. 中国临床解剖学杂志， 2020， 38（5）： 506-510. DOI： 10.13418/j.issn.1001-165x.2020.05.003.Yin TK， Wang SS. MRV study of falcine sinus in parasagittal meningioma［J］. Chin J Clin Anatomy， 2020， 38（5）： 506-510. DOI：10.13418/j.issn.1001-165x.2020.05.003.
［15］	Yin T， Zhang H， Wang W， et al. Falcine sinus and parafalcine collateral veins in meningiomas invading the superior sagittal sinus［J］. World Neurosurg， 2019， 132： e434-e442. DOI： 10.1016/j.wneu.2019.08.120.

项目	上矢状窦旁脑膜瘤	上矢状窦脑膜瘤
起源部位	SSS旁的外侧角区	SSS内的外侧角区
SSS形态	位置偏侧，窦腔常缩窄	位置居中，窦腔常扩大
肿瘤位置	主体偏向一侧，两侧体积差别大	主体居中，SSS两侧的体积相当
肿瘤形态	类球形	椭球/细长型
受累皮质静脉数量	较少	较多
SSS受累长度	较短	较长
肿瘤切除策略	自瘤体较大侧开始切除，向窦内扩展	自窦内开始切除，向两侧、向前后扩展
凸面硬脑膜切除范围	肿瘤较大侧可以较多	两侧均宜严格控制
SSS处理策略	争取切除闭塞段SSS，视情况保留对侧窦壁	全切除闭塞段SSS

项目	上矢状窦旁脑膜瘤	上矢状窦脑膜瘤
起源部位	SSS旁的外侧角区	SSS内的外侧角区
SSS形态	位置偏侧，窦腔常缩窄	位置居中，窦腔常扩大
肿瘤位置	主体偏向一侧，两侧体积差别大	主体居中，SSS两侧的体积相当
肿瘤形态	类球形	椭球/细长型
受累皮质静脉数量	较少	较多
SSS受累长度	较短	较长
肿瘤切除策略	自瘤体较大侧开始切除，向窦内扩展	自窦内开始切除，向两侧、向前后扩展
凸面硬脑膜切除范围	肿瘤较大侧可以较多	两侧均宜严格控制
SSS处理策略	争取切除闭塞段SSS，视情况保留对侧窦壁	全切除闭塞段SSS

[1]	Zhengdong Jiang, Xuqi Li, Shufeng Wang, Guangbing Wei. Laparoscopic surgery strategy for recurrent inguinal hernia and the observation of therapeutic effects [J]. Chinese Journal of Hernia and Abdominal Wall Surgery(Electronic Edition), 2023, 17(05): 539-543.
[2]	Guiyun Li, Qiang Feng, Zhiyuan Wang, Huan Luo, Fangfang Li, Li Bian. Clinicopathological analysis of 42 cases of minute pulmonary meningothelial-like nodules [J]. Chinese Journal of Lung Diseases(Electronic Edition), 2024, 17(01): 30-34.
[3]	Xiaolong Ma, Xu Guan, Runkun Yang, Zhixun Zhao, Enrui Liu, Haiyang Huang, Haipeng Chen, Zheng Liu, Zheng Jiang, Yinggang Chen, Xishan Wang. Improved survival in synchronous liver metastases with colorectal cancer is associated with surgical strategy [J]. Chinese Journal of Colorectal Diseases(Electronic Edition), 2021, 10(02): 194-200.
[4]	Dong Zhong. Individualized full process management of cerebral convex meningioma [J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2023, 09(04): 193-198.
[5]	Lihua Chen, Yong Xia, Hongzhi Huang, Fan Wei, Kai Sun, Wenjin Chen, Ruxiang Xu. Effect of anterior clinoid process osteotomy and optic canal opening on the treatment of anterior clinoid meningioma [J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2023, 09(03): 142-148.
[6]	Jianwu Wu, Yehuang Chen, Liang Xue, Yinxing Huang, Shousen Wang, Liangfeng Wei. Predictive value of MR-T2WI histogram for the texture of spinal meningioma [J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2022, 08(06): 329-334.
[7]	Hao Wu, Yusheng Shen, Yunlei Li, Mingyue Lyu, Mijiti Maimaitili, Gonggaoang Bate, Guohua Zhu. Efficacy analysis of modified vertical incision combined with supratentorial approach for resection of falcate tentorial meningioma [J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2021, 07(05): 271-276.
[8]	Lihua Chen, Hongtian Zhang, Kai Sun, Wenjin Chen, Ruxiang Xu. Diagnosis and surgical strategy of internal auditory canal meningioma [J]. Chinese Journal of Neurotraumatic Surgery(Electronic Edition), 2020, 06(05): 308-311.
[9]	Lihua Chen, Yong Xia, Fan Wei, Kai Sun, Hongzhi Huang. Study on the factors influencing postoperative visual acuity of anterior clinoid meningioma [J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2022, 12(06): 332-337.
[10]	Baoshu Xie, Kejun He, Xixi Li, Lixuan Yang, Zhengsong Huang, Nu Zhang. Effect analysis of different surgical approaches for petroclival meningiomas [J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2022, 12(01): 38-42.
[11]	Kaidong Liu, Jinsong Li, Zong Zhuang, Wei Dai, Chunhua Hang. Protection for optic nerve of early-stage extradural anterior micro-clinoidectomy for anterior clinoid process meningioma [J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2021, 11(05): 273-276.
[12]	Haiping Ling, Shijie Na, Tao Liu, Zong Zhuang, Yuhua Zhang, Chunhua Hang, Qingrong Zhang. Preoperative embolization of giant convex meningioma [J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2021, 11(04): 209-214.
[13]	Lihua Chen, Yong Xia, Fan Wei, Kai Sun, Wenjin Chen, Hongtian Zhang, Ruxiang Xu. Analysis and prevention of postoperative complications of anterior clinoid meningioma [J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2021, 11(03): 147-152.
[14]	Jianhao Lin, Yehai Li, Jing Ye, Fobao Huang, Guilu He, Qiao Li, Liang Zhang. Microsurgery of trigonal meningioma of the lateral ventricle through parietooccipital cortex approach [J]. Chinese Journal of Brain Diseases and Rehabilitation(Electronic Edition), 2021, 11(02): 92-96.
[15]	Jun Xu, Yuanyuan Ji, Junping Chen, Jian Wang. Meningioma with rosettes with skull invasion: a case report and literature review [J]. Chinese Journal of Clinicians(Electronic Edition), 2023, 17(08): 916-919.

Please choose a citation manager

Content to export