Management of Minor Superior Sagittal Sinus Laceration in Parasagittal Meningioma Surgery: Operative Video.

Abstract

Superior sagittal sinus (SSS) injury represents a potentially serious intraoperative complication during parasagittal meningioma surgery. Although primary venous repair with direct suturing remains the preferred reconstructive strategy when technically feasible, selected minor sinus wall injuries may require less manipulative hemostatic strategies aimed at preserving venous patency while minimizing sinus manipulation. We report the case of a 44-year-old male with multiple intracranial meningiomas who underwent resection of a right frontal parasagittal lesion located at the junction between the anterior and middle thirds of the SSS. Preoperative imaging demonstrated tumor adherence without intraluminal invasion (Sindou grade I) and preserved sinus patency. During coagulation of the dura attachment using a thulium laser, a minor sinus wall laceration occurred. Given the small defect size, preserved sinus morphology, and limited wall disruption, the injury was managed using a collagen-based fibrin sealant patch (TachoSil®), achieving rapid and stable hemostasis without requiring direct suturing or additional repair maneuvers. Gross total resection (Simpson grade I) was achieved. Postoperative MRI with venography confirmed complete tumor removal and preserved sinus patency without thrombosis, stenosis, or hemorrhagic complications. The patient had an uneventful recovery and remained neurologically intact at 3-month follow-up. Histology confirmed WHO grade I fibroblastic meningioma. This case highlights the importance of tailoring the management of minor SSS injuries according to defect size, sinus patency, and anatomical context. In highly selected situations, collagen-based sealant patches may represent a reasonable adjunct for achieving rapid hemostasis while preserving venous flow. An operative video illustrating the complication and its management is provided.