AL-MEFTY COLLECTION Resection of Giant Invasive Parasagittal Atypical Meningioma With a Venous Graft Reconstruction of the Sagittal Sinus: 2-Dimensional Operative Video Emad Aboud, MD ∗ , Wardan Almir Tamer,MD ‡ , Walid Ibn Essayed, MD § , Ossama Al-Mefty, MD § ∗ Arkansas Neurological Institute, Little Rock, Arkansas, USA; ‡ Department of Neurosurgery, Faculty of Medicine, Hama University, Hama, Syria; § Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA Correspondence: Ossama Al-Mefty, MD, Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA. Email: almeftyossama@bwh.harvard.edu C  Congress of Neurological Surgeons 2021. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com Parasagittal meningioma becomes challenging when it involves the sagittal sinus and frequently invades the skull 1 ; hence, resection of the invasive bone and management of the involved sinus are the two crucial issues in these tumors; notwithstanding the practice of conservative surgical resection coupled with irradi- ation (radiosurgery or stereotactic radiotherapy), 2 radical surgical removal, including the invaded bone and sinus (Simpson grade I), alleviates recurrences. It is more valuable and particularly recommended in grade II menin- giomas, 3 since radical surgery is the principal factor in a long control of grade II meningioma 4 and radiation efectiveness is directly related to gross total removal. 5 On the other hand, removal of tumor involving the sinus and sinus reconstruction has been recommended and practiced for years. 6- 10 When the sinus is occluded, preservation of the collateral venous drainage becomes paramount. 11 If the collateral venous drainage included cutaneous and dural channels, as in this patient, recon- structing of the sinus would become preventative of a major venous complication. Sindou et al 8 even advocate the routine reconstruction of occluded sinus to minimize morbidity. The patient is 39 yr old with a giant parasagittal menin- gioma that invaded the skull, occluded the sinus at the mid-third, and had venous collateral through the dura and cutaneous veins. He underwent radical resection with reconstruction of the sinus by saphenous vein graft. Patient consented for the operation and publication of images. Illustrations at 1:51 and 2:15 from Al-Mefty O, Operative Atlas of Meningiomas, C  LWW, 1997, with permission. KEY WORDS: Brain tumor, Meningioma, Sagittal sinus, Bone invasion, Sinus venous graft, Cerebral venous collateral, WHO grade II Operative Neurosurgery 0:1–2, 2021 https://doi.org/10.1093/ons/opab232 Received, February 12, 2021. Accepted, May 3, 2021. Watch now at https://academic.oup.com/ons/article-lookup/doi/10.1093/ons/opab232 OPERATIVE NEUROSURGERY VOLUME 0 | NUMBER 0 | 2021 | 1 Downloaded from https://academic.oup.com/ons/advance-article/doi/10.1093/ons/opab232/6309704 by guest on 07 July 2021