Brain Tumor Res Treat.  2016 Oct;4(2):124-127. 10.14791/btrt.2016.4.2.124.

Failed First Craniotomy and Tumor Removal of Parasagittal Meningioma with Severe Peritumoral Brain Edema

• Shim Y
• Lee SH

• KMID: 2356981
• DOI: http://doi.org/10.14791/btrt.2016.4.2.124

Abstract

Parasagittal meningioma often presents as peritumoral brain edema (PTBE). The risk of edema increases when the tumor occludes the superior sagittal sinus (SSS). Although PTBE may be expected based on the patient's symptoms or radiologic findings, extensive brain swelling and extracranial herniation during elective surgery are rare. Herniation during surgery could lead to irreversible neurological damage and even brain rupture. We report a case of a failed routine craniotomy for a parasagittal meningioma with complete occlusion of the posterior third of the SSS in a 30-year-old male patient. The patient developed extensive brain swelling and extracranial herniation during surgery.

Keyword

Meningioma; Brain edema; Craniotomy

MeSH Terms

Adult
Brain Edema*
Brain*
Craniotomy*
Edema
Humans
Male
Meningioma*
Rupture
Superior Sagittal Sinus

Figure

• 

  Fig. 1 Preoperative magnetic resonance imaging and cerebral angiographic findings. T2-weighted axial image shows dural-based iso-signal intensity mass in the parietal convexity along the superior sagittal sinus (SSS) with extensive perilesional edema (A); gadolinium-enhanced axial and sagittal image shows homogenous enhancement pattern (B and C); and right internal carotid angiography shows total occlusion of posterior third of the SSS (D).

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  Fig. 2 Transdural observation of the cortical arteries, veins, and venous sinus was performed using indocyanine green (ICG) videography. Visualization of the dural attachment of meningioma enabled safe and appropriate dural opening, minimizing damage to the venous channels. General microscopic findings (A) and ICG videographic findings (B). The black open arrows mark the tumor margin, and the white closed arrows mark the right lateral border of posterior third of the superior sagittal sinus.

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  Fig. 3 Postoperative magnetic resonance imaging and venographic findings. Venography shows no residual enhancing mass and intact anterior superior sagittal sinus and other sinus drainage (straight, transverse, and sigmoid sinuses).

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