CC BY-NC-ND 4.0 · J Neurol Surg Rep 2023; 84(03): e92-e102
DOI: 10.1055/s-0043-1772201
Original Report

Surgical Management of Meningiomas Involving the Torcula, Transverse Sinus, and Jugular Bulb: A Technical Note and Review of the Literature

Robert G. Power
1   Division of Neurosurgery, DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
Fred C. Lam
1   Division of Neurosurgery, DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
Anthony C. Whitton
2   Department of Radiation Oncology, Juravinski Cancer Centre, Hamilton, Ontario, Canada
3   Juravinski Cancer Centre, Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada
Sunjay Sharma
1   Division of Neurosurgery, DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
1   Division of Neurosurgery, DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
3   Juravinski Cancer Centre, Hamilton Health Sciences Corporation, Hamilton, Ontario, Canada
› Author Affiliations


Meningiomas that invade the confluens sinuum are rare and require extensive preoperative planning. Here, we describe the surgical and radio-oncological management of an aggressive large occipital meningioma invading the superior sagittal sinus, torcula, right and left transverse sinus down to the level of the jugular bulb in a 21-year-old female patient. Details of the surgical approach are presented to highlight the planned staged resection of this tumor at the level of the torcula to initially debulk the lesion while preserving venous outflow through the patent's sinus. Once the tumor fully occluded the confluens, a second-stage en bloc resection ensued. Postsurgical adjuvant radiation therapy was delivered via fractionated external beam therapy which has provided local control of the tumor since. This case is being discussed in the context of the pertinent literature to demonstrate the highly complex interdisciplinary and staged management of partially intravascular meningiomas involving the major venous sinuses.

Publication History

Received: 21 February 2021

Accepted: 26 January 2023

Article published online:
25 August 2023

© 2023. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (

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