Assessing Predictors of Cerebrovascular Complications Associated with Surgery for Superior Sagittal Sinus Meningiomas

Introduction: Up to one-third of all intracranial meningiomas arise from the superior sagittal sinus (SSS). Surgical management of superior sagittal sinus meningiomas remains challenging due to risk of cerebrovascular complications from affecting the delicate balance of venous drainage. This study investigates factors associated with cerebrovascular complications after resection.

Methods: This retrospective cohort study assessed 30-day post-operative complications in adults with SSS tumors undergoing open surgical resection. SSS invasion was graded as I (attached), II ( < 50% invasion), III (>50% invasion), and IV (complete occlusion with invasion to the contralateral side). Peri-tumoral brain edema was graded as I (no edema), II (edema diameter 1-99% of tumor diameter), III (edema diameter 100-199% of tumor diameter), and IV (≥200% tumor diameter). Cerebrovascular complications included venous or arterial infarcts and hemorrhage. Associations with cerebrovascular complications were assessed using univariate and multivariate regression.

Results: 128 patients were included in the analysis with surgeries ranging from 2004-2024. The mean age was 58.9 ± 15.3, 35.9% of patients were male, and mean follow-up duration was 54.9 ± 46.2 months. The mean maximum tumor diameter was 4.4 ± 1.7 cm. 78.9% achieved gross total resection, 19.5% subtotal resection, and 1.6% biopsies. SSS involvement was anterior third (60.9%), middle third (31.2%), or posterior third (7.8%). SSS invasion (grades II-IV) occurred in 66.4% and 61.4% had edema (grades II-IV). Thirty-three (25.8%) patients experienced ≥1 cerebrovascular complications. Of the peri-operative values assessed, blood loss was the only variable associated with cerebrovascular complications on univariate (p = 0.003) and multivariate analysis (p=0.003 when adjusted for tumor location).

Conclusion : Surgical management remains the mainstay of treatment for patients with SSS meningiomas. These results highlight that invasion level, edema grade, tumor location, and attainment of gross total resection are not associated with cerebrovascular complications.