Successfully Treated Parasagittal Meningioma Filling the Posterior One Third-Superior Sagittal Sinus with Upfront Stereotactic Radiosurgery without Resection

Abstract

We herein describe a superior sagittal sinus (SSS) meningioma with a complete occlusion of flow in the sinus and its successful treatment with stereotactic radiosurgery (SR). A previously healthy 41-year-old man with no prior medical history presenting with 2 months of progressive headaches, visual changes and 2 ictal episodes of generalized tonic-clonic seizures. On physical examination, he had biateral papilledema, blurring and temporal pallor of the optic papillae edges. Gadolinium-enhanced magnetic resonance imaging (MRI) of the brain revealed a posterior median interhemispheric extra-axial mass measuring 29×27×50 mm, developed in hemisphere from a wide base of meningeal implantation on the layers of the posterior one third of the SSS, indicating a parasagittal meningioma (PSM) along the posterior one third of the SSS. The mass was isointense on T1 (Figure 1A) with intense and homogeneous enhancement after injection of gadolinium (Figure 1B), and hyperintense on T2, FLAIR and diffusion-weighted images (Figure 1C, 1D, 1E). There is also a meningeal contrast uptake all around creating a "dural tail" appearance. This process invades the lumen of the SSS, completely obstructing its lumen, without involvement of the adjacent cortical veins which remain permeable.