Operative Technique in a Resection of Solitary Fibrous Tumor within the Sigmoid Sinus: Technical Note and Case Presentation.

Abstract

Background: Intracranial solitary fibrous tumors (SFTs) are rare mesenchymal tumors often presenting with dural-based lesions. These tumors can exhibit aggressive characteristics with high recurrence rates and extracranial metastasis. While SFTs occasionally invade venous sinuses, cases where the tumor arises within the venous sinus are rare. This case explores the surgical strategy for removing SFT occupying the sigmoid sinus and the jugular bulb while preserving the flow of the vein of Labbe. Clinical Presentation and Surgical Techniques: A 59-year-old woman with progressive left hearing loss and facial nerve palsy was diagnosed with a left temporal bone tumor mainly located in the sigmoid sinus and the jugular bulb. Imaging revealed a vascularized tumor with occlusion of the left sigmoid sinus and the vein of Labbe was preserved via retrograde perfusion of the transverse sinus. After preoperative embolization, surgery was performed using a trans-sigmoid approach. The tumor was carefully extracted, and the sigmoid sinus was ligated distant from the transverse-sigmoid junction to avoid the occlusion of the vein of Labbe outlet. Subtotal resection was achieved, and the patient experienced full recovery from facial paralysis within three weeks. Postoperative radiotherapy was administered, and no recurrence was observed one year later.

Conclusion: SFTs arising within venous sinuses are rare but require thorough surgical planning, especially near critical venous structures like the vein of Labbe. This case highlights the feasibility of the operative technique of extracting the tumor from venous sinuses and the importance of individualized strategies for maximizing resection while preserving neurological function and venous patency.