Compensation pathways for venous drainage of the brain in superior sagittal sinus occlusion by parasagittal meningioma




superior sagittal sinus, occlusion of superior sagittal sinus, cerebral collateral flow, parasagittal veins, meningioma, parasagittal meningioma, cerebral digital subtraction angiography


This study aims to determine the existing pathways of collateral cerebral circulation in parasagittal meningiomas that cause superior sagittal sinus occlusion based on literature review and analysis of own clinical observations. Results of clinical and instrumental examination of 221 patients treated in Dnipropetrovsk Regional Clinical Hospital named after I.I. Mechnikov from 2000 to 2021 were subjected to retrospective and prospective analysis. Inclusion criteria were: patient age of 18+, parasagittal extracerebral tumor according to computed tomography/magnetic resonance imaging, histologically verified meningioma, superior sagittal sinus occlusion (type V-VI according to M.P. Sindou and J.E. Alvernia) according to selective cerebral angiography. This study is based on the analysis of examination of 43 patients who met the inclusion criteria. The selected patients were analyzed for demography (sex, age), brain computed tomography/magnetic resonance imaging before and after intravenous contrast enhancement, and computed tomography angiography and selective cerebral angiography data. Transformed venous drainage pathways were analyzed depending on the location of superior sagittal sinus occlusion by parasagittal meningioma: anterior, middle, or posterior third of the superior sagittal sinus. It was determined that preoperative diagnosis of parasagittal meningiomas that, based on brain computed tomography/magnetic resonance imaging, has signs of type V or VI superior sagittal sinus invasion according M.P. Sindou and J.E. Alvernia, must include selective cerebral angiography. Dynamic images of selective cerebral angiography in the venous phase allows to fully assess the established pathways of collateral blood flow and the blood flow direction. Information on collateral venous circulation in case of superior sagittal sinus occlusion by parasagittal meningioma is extremely important in a surgery planning. It helps avoiding iatrogenic damage to eloquent veins, which increases radical tumor removal with maintaining/improving a patient’s functional state in the early postoperative period and improving long-term treatment outcomes.


Antomonov MYu. [Mathematical processing and analysis of biomedical data]. Kyiv: Medinform. 2018. Ukrainian.

Wang X, Wang MY, Qian K, Chen L, Zhang FC. Classification and Protection of Peritumoral Draining Veins of Parasagittal and Falcine Meningiomas. World Neurosurg. 2018;117:362-70. doi:

Wang S, Ying J, Wei L, Li S, Jing J. Effects of parasagittal meningiomas on intracranial venous circulation assessed by the virtual reality technology. Int J Clin Exp Med. 2015;8(8):12706-15.

Louis DN, Perry A, Wesseling P, Brat DJ, Cree IA, Figarella-Branger D, et al. The 2021 WHO Clas¬sification of Tumors of the Central Nervous System: a summary. Neuro-Oncology. 2021:23(8);1231-51. doi:

Yin T, Zhang H, Wang W, Zhang L, Wang S. Falcine Sinus and Parafalcine Collateral Veins in Menin-giomas Invading the Superior Sagittal Sinus. World Neurosurg. 2019;132:434-42. doi:

Giordan E, Sorenson TJ, Lanzino G. Optimal surgical strategy for meningiomas involving the superior sagittal sinus: a systematic review. Neurosurg Rev. 2020;43(2):525-35. doi:

Mathiesen T. Parasagittal meningiomas. Handb Clin Neurol. 2020;170:93-100. doi:

Gatterbauer B, Gevsek S, Höftberger R, Lütgendorf-Caucig C, Ertl A, Mallouhi A, et. al. Multimodal treatment of parasagittal meningiomas: a single-center experience. J Neurosurg. 2017;127(6):1249-56. doi:

Ricci A, Di Vitantonio H, De Paulis D, Del Maestro M, Gallieni M, Dechcordi SR, et. al. Parasagittal meningiomas: Our surgical experience and the reconstruction technique of the superior sagittal sinus. Surg Neurol Int. 2017 Jan;8:1.


Zeeshan Q, Patel A, Cheng CY, Zhao NH, Bar-ber J, Ghodke BV, et al. Resection of Meningiomas Invol-ving Major Dural Venous Sinuses: Classification, Technique, and Long-Term Results. World Neurosurg. 2019;125:521-36. doi:

Ottavio Tomasi S, Umana GE, Scalia G, Raudino G, Graziano F, Palmisciano P, et. al. The Superficial Anastomosing Veins of the Human Brain Cortex: A Microneurosurgical Anatomical Study. Front. Surg. 2022;8:817002. doi:



How to Cite

Sirko A, Dziak L, Perepelytsia V, Cherednychenko Y. Compensation pathways for venous drainage of the brain in superior sagittal sinus occlusion by parasagittal meningioma. Med. perspekt. [Internet]. 2022Dec.29 [cited 2024Feb.21];27(4):87-94. Available from: