Microsurgical Management of Complex Meningiomas Involving Dural Venous Sinuses: Operative Techniques, Case Illustrations and Long-Term Outcomes in a Series of 70 Cases

Meningiomas involving the dural venous sinuses present unique therapeutic challenges. While gross total resection remains the mainstay of treatment for meningiomas, involvement of critical vascular structures may limit extent of resection and increase the risk of recurrence. Optimal management of meningiomas with venous sinus involvement has been discussed in the literature, with some advocating for subtotal resection with postoperative surveillance and radiation, if necessary, while others recommend total resection with reconstruction of resection of the involved sinus. We performed a review of our series of 70 patients at a single institution who underwent resection of a meningioma involving the dural venous sinuses with reconstruction as needed, evaluating demographics, preoperative assessment of venous anatomy, surgical technique, and outcomes. In our series, we found successful maximal safe resection was achievable in patients with dural venous sinus involvement. We identified no venous infarctions and a low rate of recurrence. Maximal safe resection, including resection and reconstruction of involved sinuses, may be a safe and effective treatment for many patients. Careful preoperative assessment of venous anatomy and planning extent of resection and reconstruction are essential for safe and successful surgery in these patients.