• Giandomenico Petrella, Amedeo Piazza, Arianna Fava, Nicola Gorgoglione, Michelangelo De Angelis, Tommaso Vangelista, Riccardo Morganti, Paolo di Russo, and Vincenzo Esposito.
• Department of Neurosurgery, I.R.C.C.S. Neuromed, Pozzilli, Italy; Department of Neurosurgery, Policlinico di Bari, Bari, Italy.
• World Neurosurg. 2024 Jun 1; 186: e683e693e683-e693.

BackgroundSurgical management of parasagittal meningiomas (PMs) remains controversial in the literature. The need to pursue a resection as radical as possible and the high risk of venous injuries contribute to making the sinus opening a widely argued choice. This study aimed to analyze factors affecting the risk of recurrence and to assess clinical outcomes of patients who underwent surgical resection of PMs with conservative or aggressive management of the intrasinusal portion.MethodsA single-institution retrospective review of all patients with PM surgically treated between January 2013 and March 2021 was conducted.ResultsAmong 56 patients, the sinus was opened in 32 patients (57%), and a conservative approach was used in 24 patients (43%). The sinus opening was found to be a predictive factor of radical resection (Simpson grade [SG] I-II) (P = 0.007). SG was the only predictive factor of recurrence (P < 0.001). The radical resection group (SG I-II) showed recurrence-free survival at 72 months of about 90% versus 30% in the non-radical resection group (SG III-IV) (log-rank test = 14.21, P < 0.001). Aggressive management of the sinus and radical resection were not found to be related to permanent deficit (P = 0.214 and P = 0.254) or worsening of Karnofsky performance scale score (P = 0.822 and P = 0.933).ConclusionsRemoval of the intrasinusal portion of the tumor using standard procedures is not associated with a higher risk of permanent deficit or worsening of Karnofsky performance scale and reduces the risk of recurrence.Copyright © 2024 Elsevier Inc. All rights reserved.

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