Complex treatment of parasagittal meningiomas: the state of the art

Kozlov A.V.

(Burdenko Research Neurosurgical Institute of the Russian Academy of Medical Science, Moscow, Russia)

Complex treatment of parasagittal meningiomas remains an important problem because of high rates of tumor recurrence and disability of patients. Study of clinical-morphologic correlations and molecular biology of meningiomas is indicative of genetic heterogeneity of tumors, referred to a group of meningiomas. Thus, the main factor is efficacy of tumor removal.

There is an opinion, that possibility of performing radical interventions in a parasagittal area is rather limited and increase of efficacy results in inevitable growth of invalidism and mortality.

We analyzed an effect of intervention peculiarities (1500 operations performed mainly by Gabibov G.A.) on the nearest and remote results. It demonstrated (p<0.05 in all cases), that such "aggressive" manipulations as bilateral trephination even in unilateral parasagittal meningiomas, extended resection of affected or suspicious dura mater, marginal resection of the upper sagittal sinus and its partial or total reconstruction (27 patients) had led to evident reduction of invalidism and mortality. And what is more, we managed to achieve mortality and morbidity, equal to 0% and 0.7% respectively in the last series of 140 patients.

Reasonable increase of operation efficacy causes no additional invalidism, but on the contrary improves quality of life of patients with parasagittal meningiomas in the nearest and remote postoperative periods.