What are the symptoms of frontal superior sagittal sinus meningioma involvement?

Symptoms of Frontal Superior Sagittal Sinus Meningioma Involvement

Frontal superior sagittal sinus meningiomas primarily present with headache, seizures, and motor deficits, with symptoms reflecting both increased intracranial pressure from venous obstruction and focal brain injury from mass effect on the frontal lobes and parasagittal cortex.

Primary Clinical Manifestations

Increased Intracranial Pressure Symptoms

• Headache is the most common presenting symptom, occurring in the majority of patients with superior sagittal sinus involvement 1
• The headache is typically diffuse and progressive over days to weeks, rather than acute in onset 1
• Papilledema may develop due to impaired venous drainage through the superior sagittal sinus 1
• Drowsiness and vomiting can occur as manifestations of elevated intracranial pressure 1
• Visual disturbances including blurred vision and diplopia (from sixth nerve palsy) may be present 1, 2

Focal Neurological Deficits

• Motor deficits affecting the limbs are common, particularly when the tumor involves the parasagittal frontal region 1
• Bilateral motor signs including paraparesis can occur specifically with sagittal sinus thrombosis and bihemispheric injury from venous congestion 1
• Hemiparesis may develop when focal brain injury occurs from venous ischemia or mass effect 1
• Seizures are a presenting symptom in up to 30% of meningiomas, representing focal cortical irritation 1

Physical Examination Findings

• Scalp edema and dilated scalp veins may be visible on examination when the superior sagittal sinus is involved 1
• Frontal bossing or tumor formation on the cranial vault can occur, particularly in younger patients with transosseous extension 1, 3
• Cranial nerve palsies may be present depending on the extent of involvement 1

Location-Specific Considerations

The superior sagittal sinus is the most commonly involved venous structure in parasagittal meningiomas 1. When the frontal portion is affected:

• Frontal lobe symptoms predominate, including personality changes and executive dysfunction (though these are often subtle and underreported) 1
• Motor symptoms are more prominent when the tumor extends posteriorly toward the motor strip 1, 4
• Bilateral involvement is possible due to the midline location and potential for bilateral venous drainage impairment 1

Temporal Pattern of Symptom Onset

• Symptoms typically develop subacutely over days to weeks rather than acutely 1
• Meningiomas in children tend to be larger at presentation compared to adults, potentially leading to more pronounced symptoms 1
• Progressive worsening is characteristic as the tumor grows and venous obstruction increases 1, 2

Critical Diagnostic Pitfalls

Isolated headache without focal neurological findings occurs in a significant minority of patients, presenting a major diagnostic challenge that can lead to delayed diagnosis 1. The combination of headache with papilledema should always raise suspicion for superior sagittal sinus pathology, even without other focal signs 1.

Bilateral symptoms or bilateral motor deficits should specifically prompt consideration of sagittal sinus involvement, as this pattern is uncommon in other cerebrovascular diseases but characteristic of venous pathology 1.

The presence of scalp findings (edema, dilated veins) provides an important external clue to underlying superior sagittal sinus involvement that should not be overlooked on physical examination 1.