Comparison of surgical, gamma knife and combined treatment results in parasagital meningiomas

Parasagittal meningiomas present treatment challenges due to their invasion into the superior sagittal sinus. While surgical excision is crucial for a cure, it can lead to dangerous complications, such as sinus bleeding, sinus occlusion, position-related air embolism, and venous infarction, depending on the lesion's relationship with the superior sagittal sinus. Nevertheless, in an effort to prevent complications, leaving tumor residue may result in tumor recurrence. In such cases, Gamma Knife radiosurgery can be successfully applied to residual tumor tissue to prevent recurrence. Consequently, a combined treatment approach is now being successfully employed for parasagittal meningiomas to minimize complications. This study aims to compare surgical, Gamma Knife, and combined (surgery + Gamma Knife) treatment methods for parasagittal meningiomas. Patients receiving treatment at Pamukkale University Hospital Brain and Neurosurgery Clinics were scanned and included in the study. The patients, who were divided into three groups for analysis based on surgical, Gamma Knife, and combined treatments and the patients were classified according to Simpson Resection classification, Sindou classification, tumor localization and patiemt's demographic and clinical data reviewed retrospectively through an archival search. The average age of the patients included in the study was 56 years old, with 68.4% being female and 31.6% male. Although tumor location did not show statistical significance between groups (p=0.121), the most common location for meningiomas was in the parietal lobe. Tumor involvement in the superior sagittal sinus region was more common, occurring in the middle 2/3 region among all groups (p=0.269). Surgical treatment was preferred for tumors located in the posterior 3/3 region, whereas surgeries were chosen for tumors in the anterior 1/3 region. Gamma Knife radiosurgery was administered to patients with a Simpson grade 4 post-operative outcome in the combined group. We believe that during treatment planning, it is crucial to consider the clinical conditions of the patients, the location of the meningiomas, and their relationship with the superior sagittal sinus. We propose that for patients with Sindou Grade 4-5-6 meningiomas, the goal should be achieving a Simpson grade 4 resection rather than complete resection. This approach allows for post-operative Gamma Knife radiosurgery to address any residual lesions, preventing tumor recurrence, while simultaneously reducing the risk of mortality or morbidity resulting from superior sagittal sinus damage.