Endovascular Stenting Following Stereotactic Radiosurgery for Meningioma Involving the Superior Sagittal Sinus

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  • Takahashi Yusuke
    Department of Neurosurgery, Yuri-Kumiai General Hospital, Yuri-Honjo, Akita, Japan
  • Suda Yoshitaka
    Department of Neurosurgery, Yuri-Kumiai General Hospital, Yuri-Honjo, Akita, Japan
  • Fushimi Susumu
    Department of Neurosurgery, Hiraka General Hospital, Yokote, Akita, Japan
  • Shibata Kenichi
    Department of Neurosurgery, Hiraka General Hospital, Yokote, Akita, Japan
  • Kondo Rui
    Department of Neurosurgery, Hiraka General Hospital, Yokote, Akita, Japan
  • Oda Masaya
    Department of Neurosurgery, Akita University Graduate School of Medicine, Akita, Japan
  • Shimizu Hiroaki
    Department of Neurosurgery, Akita University Graduate School of Medicine, Akita, Japan

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<p>Objective: Surgical removal of meningiomas that have partially invaded the superior sagittal sinus (SSS) is difficult because it requires reconstruction of the SSS, which can lead to SSS occlusion and venous infarction. The present report details the case of an SSS-involved meningioma treated by stereotactic radiosurgery (SRS) and stenting.</p><p>Case Presentation: A 60-year-old woman was admitted to the hospital with blurred vision and papilledema. Lumbar puncture showed markedly increased intracranial pressure (ICP; 340 mm H2O). Gadolinium-enhanced T1-weighted imaging revealed a 1-cm meningioma located mainly in the SSS. Digital subtraction angiography revealed severe stenosis, at the posterior part of the SSS, and no collateral flow. The ICP was considered a result of the stenosis caused by the meningioma. A combined therapy comprising transarterial embolization (for tumor growth suppression), endovascular stenting of the SSS (for intracranial hypertension improvement), and SRS (for tumor control) was planned. SRS was performed first to avoid interference by the metal artifacts caused by the stent. After placement of a self-expanding stent, partial recanalization was achieved. Two months after stenting, SSS stenosis improved and MRI results showed shrinkage of the meningioma. Thirty months after the treatment, no tumor recurrence was observed.</p><p>Conclusion: The treatment strategy of SRS followed by stenting was successful for a SSS-involved meningioma. ICP and a pressure gradient between the pre- and post-stenotic segments should be considered indications for stenting.</p>

収録刊行物

  • 脳神経血管内治療

    脳神経血管内治療 14 (7), 273-278, 2020

    特定非営利活動法人 日本脳神経血管内治療学会

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