Contralateral venous thrombosis and intracerebral hemorrhage after resection of parasagittal meningioma: a case report and systematic review

Background. Preservation of venous structures and prevention of cortical trauma during resection of parasagittal meningioma are key factors ensuring high quality after surgery. However, venous circulatory disorders are possible despite these principles. Objective. To describe contralateral cerebral venous thrombosis and compare own findings with literature data on cerebral venous thrombosis in parasagittal meningioma. Results and discussion. A 53-year-old man with parasagittal meningioma of posterior third of superior sagittal sinus bordering the middle third on the right developed local thrombosis of sinus and parietal vein, as well as contralateral secondary intracerebral hemorrhage in 9 days after surgery. We did not remove tumor remnant inside the sinus. Superior sagittal sinus was not opened. Meningioma matrix coagulation was performed using direct spray mode. Enoxaparin sodium (subsequently switched to rivaroxaban) and citicoline were prescribed. The Karnofsky score recovered to 90 points after 3 months. In accordance with the PRIZMA recommendations, we reviewed the PubMed and Google Scholar databases using the keywords «parasagittal AND meningioma AND venous AND thrombosis». We found 12 and 2.540 manuscripts, respectively. Analysis of all abstracts in PubMed database and 200 most relevant papers in Google Scholar database identified 3 eligible reports. Clearly, such complications are extremely rare. Conclusion. Contralateral thrombosis of bridging vein after resection of parasagittal meningioma is unique and deserves attention. Timely diagnosis and anticoagulation can lead to complete regression of neurological symptoms.