Middle third Parasagittal Meningiomas at Kenyatta National Hospital: Report of Five Cases Demonstrating Surgical Nuances

Abstract

Background: Parasagittal meningiomas (PSMs) are among the most common intracranial meningiomas, comprising 20–30% of cases (1). They originate from the convexity dura adjacent to the superior sagittal sinus (SSS) and are often classified according to Olivecrona’s anatomical thirds (2,3). Surgical management is challenging due to venous sinus involvement and high recurrence rates (13–40%) (4). This study presents a series of five parasagittal meningiomas managed at Kenyatta National Hospital (KNH), highlighting the operative strategies, intraoperative findings, and surgical outcomes. Methods: Five patients with radiologically and histopathologically confirmed parasagittal meningiomas underwent surgical resection at KNH between 2024 and 2025Preoperative MRI assessed tumor location relative to the SSS and MRV to assess the patency of the SSS  The surgical approach involved microsurgical excision using careful dissection of sinus wall attachments. Extent of resection was graded using the Simpson classification, and outcomes were evaluated based on postoperative neurological status, complications, and follow-up imaging over 3 months. Results: All the tumors were located in the middle third of the SSS. Four patients were female. Gross total resection (Simpson Grade II) was achieved in all 5 patients. Transient postoperative hemiparesis occurred in one patient. One tumor was noted to WHO grade II while the rest are WHO I . Four demonstrated clinical improvement and no early recurrence within 6 months. There was one mortality attributed to postoperative DVT. Conclusion: Parasagittal meningiomas remain a frequent but technically demanding subset of intracranial tumors. The middle third of the SSS is the most commonly affected region (5,6). Preservation of venous drainage, piecemeal resection, and meticulous hemostasis are essential for minimizing morbidity (7–10). The KNH experience underscores that with careful microsurgical technique and perioperative planning, favorable outcomes can be achieved even in resource-limited settings.