Recurrence in parasagittal meningiomas: analysis of surgical radicality, histological subtype, and sagittal sinus invasion

Abstract

Parasagittal meningiomas (PSM), accounting for up to 40% of intracranial meningiomas, pose significant neurosurgical challenges due to their anatomical relationship with the superior sagittal sinus (SSS). This study examines the recurrence risk factors following surgical treatment and therapeutic solutions. The study aims to analyze the anatomical, histological and clinical factors influencing the recurrence of parasagittal meningiomas, in order to improve therapeutic and prognostic strategies. Retrospective-analytical study carried out through comparative analysis of data from the literature. Anatomical, histological, and operative factors were evaluated, using the WHO 2021 classification, Simpson grade, and parameters such as peritumoral edema, tumor consistency, and SSS invasion. Statistical tests included χ² and Pearson correlations. Recurrence was influenced by the grade of resection: recurrence-free rates at 5/10/15 years were 93%/80%/68% for Simpson grades I-II, and 63%/45%/9% for grades III-IV (p<0.05). Soft tumors, with dural or osseous invasion, recurred in 56% of cases. Atypical/anaplastic histology and overt cerebral infiltration are associated with a poor prognosis. Peritumor edema and the cystic components, although frequently encountered, did not have a consistent predictive value. Multifocality and a low Karnofsky index were associated with an increase in recurrence, especially in cases with limited resection due to anatomical factors. The extent of resection remains the main determinant of postoperative outcome in patients with PSM. Histological type, macro-morphological aspects, and preoperative functional status influence the risk of recurrence. Prospective studies are needed to validate these factors.