Parasagittal Meningiomas: the impact of sinus opening and grade of resection on clinical outcome and recurrence in a consecutive series of patients.

Background Surgical management of parasagittal meningiomas (PMs) still remains controversial in literature. The need to pursue a resection as radical as possible along with the high risk of venous injuries contribute to making the sinus opening a widely argued choice. The aim of our study was to analyze factors affecting the risk of recurrence and to assess clinical outcome of patients that underwent surgical resection of PMs with conservative or aggressive management of the intrasinusal portion. Methods A single institution retrospective review of all patients with PM surgically treated from January 2013 and March 2021 was conducted. Results Among 56 patients, sinus was opened in 32 patients (57%) while 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 = ,007). The SG resulted being the only predictive factor of recurrence (P < 0,001). The radical-resection group (SG I+II) showed a recurrence-free survival (RFS) at 72 months about 90% vs 30% in the non-radical group (SG III+IV) (log-rank test, 14,21; P < ,001). Aggressive management of the sinus and radical resection were not found to be related to permanent deficit (P = 0,214; P = 0,254) or worsening of the KPS (P = ,822; P = 0,933), respectively. Conclusion Removal of the intrasinusal portion of the tumor using standard procedures is not associated with a higher risk of permanent deficit or worsening of the KPS, while reducing the risk of recurrence.