The overlying bone may be involved in tumor and in some cases there may be hyperostosis. In general terms, the anterior third of the sinus extends from the cristi galli to the coronal suture, the middle third from the coronal to the lambdoid suture, and the posterior third from the lambdoid suture to the torcula. Embolization has not been needed. The indications for surgery are worsening neurological symptoms, seizure in younger patients, and regrowth after radical subtotal removal. Radiation therapy has not been used.
Observation is recommended in many older patients with a seizure or minimal symptoms.
Positions and incisions for operation. The approximate center of the tumor is the highest point. Anterior third of sagittal sinus. Middle third of sagittal sinus. Posterior third of sagittal sinus.