Skull Base Surgery of the Posterior Fossa

131

Fig. 9.10 Case 8. Preoperative axial (a) and coronal (b)
T1-weighted magnetic resonance images with gadolinium
showing the posterior type of tentorial meningioma.
Preoperative MR venography shows invasion of the right

transverse sinus (c). Postoperative axial (d) T1-weighted

magnetic resonance images with gadolinium showing

total resection of the tumor, including the part invading

the sinus, via a suboccipital approach

Case 9: Aggressive Resection
with Reconstruction of the Superior
Sagittal Sinus (Fig. 9.11)
A 47-year-old woman who had twice undergone
tumor resection and γ-knife treatment at a previous
hospital showed recurrent tumor at the torcular
Herophili. Preoperative CT venography demon-

strated occlusion of the straight sinus and left

transverse sinus, but venous flow from the supe-

rior sagittal sinus to the right transverse sinus was

preserved. Thus, an aggressive resection with

reconstruction of the sinus using a saphenous vein

graft was performed. Simpson G1 removal of the

tumor was performed without any complications.

9 Tentorial Meningiomas