Q12441 [Neurosurgery Wiki]

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====== Q12441 ======

====== Case Report ======

===== Title =====
Successful Management of [[Parasagittal Meningioma]] in a 41-Year-Old Woman: A Case Report

===== Abstract =====
We present the case of a 41-year-old woman diagnosed with parasagittal meningiomas who underwent successful surgical resection. The primary tumor caused [[focal epilepsy]] and other neurological symptoms. The case highlights the challenges of managing parasagittal meningiomas in close proximity to critical vascular structures and the importance of a multidisciplinary approach to optimize surgical and postoperative outcomes.

===== Introduction =====
Meningiomas are common intracranial tumors, typically benign, arising from the meninges. Parasagittal meningiomas, in particular, can present unique challenges due to their proximity to the superior sagittal sinus. This report details the surgical approach and clinical evolution of a patient with parasagittal meningiomas.

===== Case Presentation =====

==== Admission Reason ====
A 41-year-old woman was admitted for elective resection of a left parasagittal frontal meningioma diagnosed after focal epileptic seizures.

==== Medical History ====
  * Hypothyroidism.
  * Asthma (sporadic use of inhalers).
  * Focal epilepsy secondary to structural brain lesion (treated with Levetiracetam 1000 mg twice daily).

==== Surgical History ====
  * Laparoscopic cholecystectomy.

==== Allergies ====
  * Shellfish.

==== Current Illness ====
The patient presented with focal epilepsy secondary to a left parasagittal meningioma. Symptoms included episodes of language impairment, loss of consciousness, and tonic-clonic movements. A single episode of tongue biting occurred previously, which was not evaluated at the time. Admission was planned for definitive surgical treatment.

===== Investigations =====

==== Magnetic Resonance Imaging (MRI) and MR Venography ====
  * A 29x24x34 mm left [[parasagittal]] extraxial lesion, compatible with a meningioma.

{{:pasted:20241210-093002.png}}

  * Vasogenic edema with ventricular displacement.
  * A 7 mm focal meningioma in the right frontal convexity.

==== Computed Tomography (CT) Scan ====
  * Postsurgical changes with a small millimetric hemorrhage at the resection site.
  * Pneumocephalus and persistent edema without significant complications.

===== Surgical Procedure =====

==== Technique ====
Parasagittal craniotomy.

==== Key Details ====
  * **Left-sided lesion:** Total resection of a parasagittal meningioma adherent to the superior sagittal sinus, preserving vascular structures.
  * **Right-sided lesion:** Complete resection of a nodular extraaxial meningioma with its dural base.
  * Closure involved miniplates for cranial fixation and reinforcement of the dural defect with Duragen and Tachosil.

===== Clinical Course =====

==== Immediate Postoperative Period ====
  * Conscious and oriented, with no focal neurological deficits or seizures.

==== In the Recovery Unit ====
  * Stable hemodynamics and effective pain management.
  * Prophylactic anticonvulsant regimen maintained.

==== Ward Admission ====
  * Surgical wound clean with no signs of infection.
  * Independent ambulation.
  * Afebrile with no postoperative complications.

Histological results pending at discharge.

===== Diagnosis =====

==== Primary Diagnosis ====
  * Left parasagittal frontal meningioma.

==== Secondary Diagnoses ====
  * Focal epilepsy secondary to structural lesion.
  * Right frontal meningioma (asymptomatic).

===== Treatment at Discharge =====

==== Medications ====
  * Dexamethasone (gradual tapering).
  * Paracetamol and metamizole as needed for pain.
  * Enoxaparin 4000 IU (thromboprophylaxis).
  * Omeprazole during corticosteroid therapy.

==== Recommendations ====
  * Relative rest.
  * Daily wound care with Betadine and sterile dressing.
  * Staple removal at a primary care center.

==== Follow-up Plan ====
  * MRI before the follow-up appointment.
  * Consultation with the treating physician.
  * Neurology and Rare Diseases appointments.

===== Discussion =====
This case highlights the challenges and outcomes of managing parasagittal meningiomas. Surgical planning prioritized tumor resection while preserving the superior sagittal sinus, achieving seizure control and functional recovery. The case underscores the importance of a tailored multidisciplinary approach for complex intracranial tumors.

===== Conclusion =====
The successful resection of parasagittal meningiomas demonstrates the feasibility of preserving critical structures while achieving symptom resolution. Postoperative care and vigilant follow-up are essential to optimize long-term outcomes.

===== Keywords =====
Parasagittal meningioma, focal epilepsy, neurosurgery, surgical outcomes.