Management of Meningioma invading Superior Sagittal Sinus: Surgery and Radiosurgery

Parasagittal meningiomas that invade the superior sagittal sinus (SSS) pose a dual hazard: recurrence if tumour is left behind, and venous infarction if a functional sinus or bridging vein is compromised. The 2021 European Association of Neuro-Oncology guideline recommends observation for incidental, asymptomatic suspected meningiomas and surgery for growing or symptomatic tumours, while stereotactic radiosurgery (SRS) or fractionated radiotherapy may complement or substitute for surgery in selected settings. Contemporary series support invasion-graded decision-making radical resection with venous repair can achieve durable control in selected patients, but morbidity clusters around extensive invasion and loss of venous outflow. Radiosurgery offers high tumour control for small presumed WHO grade I lesions and for residual intra-sinus disease, with peri-tumoural oedema as the key toxicity signal. This review synthesizes key surgical and radio-surgical evidence and highlights practical decision anchors for treatment selection.