Incidence, risk factors, and outcome of venous infarction after meningioma surgery in 705 patients

Brain Tumor Research Center, Department of Neurological Surgery, University of California at San Francisco, 505 Parnassus Avenue, P.O. Box 0112, San Francisco, California 94143, USA.
Journal of Clinical Neuroscience (Impact Factor: 1.38). 02/2011; 18(5):628-32. DOI: 10.1016/j.jocn.2010.10.001
Source: PubMed


Central to safe and effective surgical resection of meningiomas is consideration of the venous anatomy both near and intrinsic to the tumor. The exact incidence of venous infarction following meningioma surgery has not been established. To determine this incidence, we present a large multivariate analysis of 705 patients undergoing craniotomy for resection of a histologically proven meningioma at our institution between 1991 and 2007. Clinical information was retrospectively reconstructed using patient medical records and radiologic data. Venous infarctions were identified by postoperative CT scans or MRI that demonstrated the typical imaging findings. Stepwise multivariate logistic regression analysis was performed to test the association with approach used and the rate of venous infarction, controlling for multiple independent variables. The overall rate of venous infarction (n=705) was 2.0% of all patients (95% confidence interval [CI], 0.9-3.0%). Interestingly, on multivariate logistic regression analysis, we found the use of a bifrontal craniotomy was the sole independent predictor of venous infarction in this regression model (odds ratio, 3.18; 95% CI, 1.03-9.77; p<0.05). We found that the rate of venous infarction was significantly reduced in the extended bifrontal group compared to the group not receiving biorbital osteotomies (0% versus 8.9%, χ(2)p<0.05). We demonstrated that the most important factor determining the risk of venous infarction is the approach used to access the tumor.

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    ABSTRACT: Although surgical excision of meningioma and its dural base is the most common primary management, skull base meningiomas are quite different, and contemporary management usually consists of multimodal treatment with the aim of achieving the best possible functional outcome and quality of life (QOL) for these patients. As surgery plays an important role in the treatment of skull base meningiomas, it is crucial for neurosurgeons to appreciate the surgical outcome and QOL after meningioma surgery. Outcome is usually measured for meningiomas in terms of morbidity, mortality, time to recurrence, and QOL. The extent of resection, tumor grade, proliferative markers, and tumor location are significant factors in predicting the surgical outcome. Therefore, we address each of these factors in detail in this review. Advances in recent decades in microsurgical techniques, neuroimaging modalities, neuroanesthesia, and perioperative intensive care have substantially improved the surgical outcome; therefore, most surgical outcomes discussed in this review are cited from contemporary literature (2000 to the present) in order to depict the surgical outcome of contemporary microsurgery.
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    ABSTRACT: Introduction: The incidence of venous infarction after surgical resection of meningioma is low, but its occurrence can necessitate additional surgical procedures and long hospital stay. In this study, we evaluated variables associated with venous infarction after meningioma surgery. Methods: Among 825 patients with intracranial meningiomas who underwent microsurgical resection between January 1993 and March 2011, 27 (3.3%) presented with neurological deterioration due to postoperative venous infarction. The following factors were included in the statistical analysis to determine their association with venous infarction: sex, age, location, relation to venous sinus, peritumoural oedema, size and degree of resection. Results: Incidence of venous infarction was 6.8% with large meningiomas (size ≥ 4 cm), but with small (size < 4 cm) was reduced to 1.2% (p < 0.001). Meningiomas with perilesional edema elicited venous infarction more frequently than those without (5.1% vs. 2.3%, p = 0.030). Venous infarction was also determined to occur at 5.5% frequency in superficial meningiomas, such as parasagittal, falx and convexity, but only at 0.5% frequency in deep locations (p = 0.001). Venous infarction additionally occurred less often in meningiomas at a distance from the midline venous sinus than in those nearby, such as parasagittal and falx (2.2% vs. 6.6%, p = 0.004). Conclusions: To prevent venous infarction after meningioma surgery, it is essential to maintain the intervening arachnoid plane as much as possible; this is especially important in meningiomas larger than 4 cm, combined with peritumoural edema or positioned superficially around the midline venous sinus.
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    ABSTRACT: Background: Maximal safe resection is the goal of correct surgical treatment of parasagittal meningiomas, and it is intimately related to the venous anatomy both near and directly involved by the tumor. Indocyanine green videoangiography (ICGV) has already been advocated as an intra-operative resourceful technique in brain tumor surgery for the identification of vessels. The aim of this study was to investigate the role of ICGV in surgery of parasagittal meningiomas occluding the superior sagittal sinus (SSS). Method: In this study, we prospectively analyzed clinical, radiological and intra-operative findings of patients affected by parasagittal meningioma occluding the SSS, who underwent ICGV assisted-surgery. Radiological diagnosis of complete SSS occlusion was pre-operatively established in all cases. ICGV was performed before dural opening, before and during tumor resection, at the end of the procedure. Results: Five patients were included in our study. In all cases, ICGV guided dural opening, tumor resection, and venous management. The venous collateral pathway was easily identified and preserved in all cases. Radical resection was achieved in four cases. Surgery was uneventful in all cases. Conclusions: Despite the small number of patients, our study shows that ICG videoangiography could play a crucial role in guiding surgery of parasagittal meningioma occluding the SSS. Further studies are needed to define the role of this technique on functional and oncological outcome of these patients.
    No preview · Article · Jan 2013 · Acta Neurochirurgica
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