# Challenging Resection of Bilateral Parasagittal and Falcine Meningioma Involving Both Anterior Third and Middle Third of the Superior Sagittal Sinus: A Case Report and Literature Review

## TL;DR

A 57-year-old man with a large meningioma involving the superior sagittal sinus underwent successful surgery with no complications or recurrence.

## Contribution

This case report highlights successful surgical resection of a complex meningioma involving the superior sagittal sinus without radiotherapy.

## Key findings

- The patient had a large bilateral parasagittal-falcine meningioma with superior sagittal sinus invasion.
- Surgical resection was successfully performed without intraoperative complications or post-operative neurological issues.
- Three months post-surgery, there was no tumor recurrence or complications.

## Abstract

Meningiomas typically manifest as benign, slow-growing, and well-defined tumors on a macroscopic level and are usually asymptomatic. However, the mass effect caused by large meningiomas may lead to various neurological symptoms, commonly headaches and visual problems. Radiological imaging can establish the diagnosis, and a biopsy can provide a definitive diagnosis. Our case report describes the surgical intervention for bilateral parasagittal-falcine meningioma in a 57-year-old male who presented to the emergency department with a tonic-clonic seizure. On examination, he had a bifrontal longitudinal mass. Magnetic resonance imaging (MRI) revealed a large anterior superior falcine extra-axial mass, measuring about 5.7 x 5.3 x 3.1 cm, with surrounding vasogenic edema and superior sagittal sinus invasion. He underwent surgery for tumor resection involving the anterior third and middle third of the superior sagittal sinus without radiotherapy. He did not develop any intraoperative complications, and during the post-operative evaluation, he was symptom-free. A follow-up MRI with contrast performed three months later showed no neurological complications or recurrent tumor. To achieve better outcomes, surgical intervention for parasagittal and falcine meningiomas involving the superior sagittal sinus should aim to eliminate clinical signs, control tumor growth, and prevent neurological deterioration post-operatively.