{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T15:30:13Z","timestamp":1772724613369,"version":"3.50.1"},"reference-count":52,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,12,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>Surgical removal of torcular meningiomas is a considerable challenge. The authors studied the anatomical structure of the torcula to identify a dissecting plane that allows for the removal of the tumor while maintaining the integrity and patency of the venous component. Here, they describe the anatomy and surgical technique applied in a cohort of patients with torcular meningiomas.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>In four formalin-fixed cadavers, the architecture of the torcula and connecting sinuses was studied using various stains. Accordingly, the authors categorized meningioma invasion of the torcula into different types based on the integrity of the venous component. They described the corresponding surgical techniques and retrospectively analyzed the medical records of a series of 14 patients with torcular meningiomas operated on between 1997 and 2018.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>The histological preparation revealed that the torcular wall consists of two distinct compartments, an inner venous structure with a layer of endothelium surrounding the lumen, supported by an extra-endothelial layer composed of elastic fibers associated with multiple layers of thin smooth muscle fibers. Surrounding this inner venous structure is the dural fibrous structure. Between the dural fibrous component and the venous component, there is a collagenous layer that forms a cleavage plane, facilitating delamination. This cleavage made it possible to resect the tumor and maintain the integrity of the venous wall and venous flow. Based on the anatomical involvement of the torcular wall, the authors categorized torcular meningiomas into four types. Fourteen patients were managed based on this classification. In types I and II, the venous compartment is intact, flow is maintained, and the surgical technique for removing the tumor is described. In types III and IV, the tumor has disrupted the venous compartment and flow, and these tumors were removed with utmost care for preservation of collateral venous channels.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>The anatomical composition of the torcular wall provides a plane of dissection to remove torcular meningiomas with preservation of venous channels and flow in cases in which the inner venous wall is not disrupted (types I and II). Tumors with occlusion of the torcula (types III and IV) mandate preservation of venous collaterals.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.4.jns25359","type":"journal-article","created":{"date-parts":[[2025,8,16]],"date-time":"2025-08-16T01:31:23Z","timestamp":1755307883000},"page":"1449-1457","source":"Crossref","is-referenced-by-count":0,"title":["Surgery of peritorcular meningiomas: the structural basis for preservation of torcular venous flow"],"prefix":"10.3171","volume":"143","author":[{"given":"Anil","family":"Can","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Mass General Brigham, Harvard Medical School, Boston, Massachusetts;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alice","family":"Giotta Lucifero","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mass General Brigham, Harvard Medical School, Boston, Massachusetts;"},{"name":"Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Brettler","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mass General Brigham, Harvard Medical School, Boston, Massachusetts;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaith","family":"Almefty","sequence":"additional","affiliation":[{"name":"Division of Neurological Surgery, Barrow Neurological Institute, St. Joseph\u2019s Hospital and Medical Center, Phoenix, Arizona;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emad","family":"Aboud","sequence":"additional","affiliation":[{"name":"Arkansas Neuroscience Institute, St. Vincent Infirmary, Little Rock, Arkansas;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andres","family":"Santos","sequence":"additional","affiliation":[{"name":"Department of Pathology, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Murat","family":"Gokden","sequence":"additional","affiliation":[{"name":"Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ian F.","family":"Dunn","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, OU Health University of Oklahoma Medical Center, Oklahoma City, Oklahoma"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ossama","family":"Al-Mefty","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Mass General Brigham, Harvard Medical School, Boston, Massachusetts;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1","series-title":"Meningiomas. 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J Neurol Surg Rep. 2023;84(3):e92\u2013e102."},{"key":"b5","series-title":"World Neurosurg","first-page":"e765","article-title":"Surgical outcome of torcula Herophili meningioma: an institutional experience","volume":"184","author":"Birua GJS","year":"2024","unstructured":"Birua GJS, Sadashiva N, Konar S,  Surgical outcome of torcula Herophili meningioma: an institutional experience. World Neurosurg. 2024;184:e765\u2013e773."},{"key":"b6","series-title":"World Neurosurg","first-page":"451","article-title":"Torcular meningioma with multi-venous sinus invasion: compensatory drainage veins and surgical strategy","volume":"109","author":"Debernardi A","year":"2018","unstructured":"Debernardi A, Quilici L, La Camera A, Boccardi E, Cenzato M. Torcular meningioma with multi-venous sinus invasion: compensatory drainage veins and surgical strategy. World Neurosurg. 2018;109:451\u2013454."},{"key":"b7","series-title":"World Neurosurg","first-page":"e437","article-title":"Surgical management of medial tentorial meningioma: falcotentorial and torcular","volume":"115","author":"Talacchi A","year":"2018","unstructured":"Talacchi A, Biroli A, Hasanbelliu A, Locatelli F. Surgical management of medial tentorial meningioma: falcotentorial and torcular. World Neurosurg. 2018;115:e437\u2013e447."},{"issue":"3-4","key":"b8","series-title":"World Neurosurg","first-page":"455","article-title":"Management of meningiomas invading the major dural venous sinuses: operative technique, results, and potential benefit for higher grade tumors","volume":"82","author":"Mantovani A","year":"2014","unstructured":"Mantovani A, Di Maio S, Ferreira MJ, Sekhar LN. Management of meningiomas invading the major dural venous sinuses: operative technique, results, and potential benefit for higher grade tumors. 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Spontaneous peritumoral haemorrhage associated with sinus confluence meningioma: case report. Surg Neurol. 2000;54(3):254\u2013259."},{"issue":"suppl 1","key":"b15","series-title":"J Neurol Surg A Cent Eur Neurosurg","first-page":"e266","article-title":"Surgical treatment of recurrent torcular meningiomas: case report and review of the literature","volume":"74","author":"Feng R","year":"2013","unstructured":"Feng R, Che X, Hu J, Pan L, Cui D, Yang L. Surgical treatment of recurrent torcular meningiomas: case report and review of the literature. J Neurol Surg A Cent Eur Neurosurg. 2013;74(suppl 1):e266\u2013e270."},{"issue":"2","key":"b16","series-title":"J Craniofac Surg","first-page":"e211","article-title":"Microsurgical treatment of meningiomas in the torcular Herophili region","volume":"27","author":"Li X","year":"2016","unstructured":"Li X, He X, Niu J, Du C, Wang J. Microsurgical treatment of meningiomas in the torcular Herophili region. 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Front Oncol. 2022;12:848851."},{"issue":"3","key":"b21","series-title":"J Neurosurg","first-page":"429","article-title":"A light and electron microscopic and immunohistochemical study of human arachnoid villi","volume":"69","author":"Kida S","year":"1988","unstructured":"Kida S, Yamashima T, Kubota T, Ito H, Yamamoto S. A light and electron microscopic and immunohistochemical study of human arachnoid villi. J Neurosurg. 1988;69(3):429\u2013435."},{"issue":"2","key":"b22","series-title":"J Neurosurg","first-page":"494","article-title":"Straight sinus: ultrastructural analysis aimed at surgical tumor resection","volume":"125","author":"Amato MC","year":"2016","unstructured":"Amato MC, Tirapelli LF, Carlotti CG Jr, Colli BO. Straight sinus: ultrastructural analysis aimed at surgical tumor resection. 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