Figure 1

Male, 56 years old, left parietal parasagittal recurrent meningioma A-C, preoperative axial, sagittal, and coronal enhanced MRI show that the tumor size is 6 cm×5 cm, located in the middle and posterior segment of the superior sagittal sinus, destroying the skull and invading the scalp, but the scalp is not damaged; D, MRI T2 fluid attenuated inversion recovery (T2 flair) sequence shows that edema of the brain tissue surrounding the tumor is evident, and the midline of the brain is slightly shifted to the right; E, CTA shows that The tumor invades extracranially along the edge of the bone window, and the extracranial blood supply of the tumor mainly comes from the superficial temporal artery and the occipital artery; F, MRV shows that there are abundant intracranial and extracranial drainage veins around the tumor, and the superior sagittal sinus is occluded; G, DSA shows that the intracranial blood supply of the tumor comes from the brain Anterior artery and middle cerebral artery; H, multimodal image reconstruction model simulates the incision and bone window extent and tumor exposure, the yellow solid line is the scalp incision, the black dotted line is the bone window, and the green is the tumor; I, postoperative CT shows that the tumor resection is satisfactory, and the edema in the surgical area is still obvious, the skull in the surgical area is removed. MRI, magnetic resonance imaging; CTA, computed tomography angiography; MRV, magnetic resonance venography; DSA, digital subtraction angiography; CT, computed tomography."

Figure 2

Male, 53 years old, recurrent meningioma of frontal and parietal lobes after 3 resections A-C, preoperative axial, sagittal, and coronal enhanced MRI show that the tumor size was about 12 cm×10 cm, located on frontal and parietal lobes, invades the middle of the superior sagittal sinus, the superior sagittal sinus is completely surrounded by the tumor, the tumor breaks through titanium mesh for skull repair and invades the scalp, and the scalp is destroyed; D, MRI T2 fluid attenuated inversion recovery (T2 flair) sequence shows mild edema in the brain tissue surrounding the tumor; E, CTA (left view) shows that the tumor invades the extracranial along the titanium mesh, and the extracranial blood supply of the tumor mainly comes from the superficial temporal artery; F, CTA (right view) shows that the intracranial blood supply of the tumor comes from the anterior cerebral artery and middle cerebral artery; G, MRV shows that the tumor has abundant drainage veins in the intracranial and extracranial periphery, the superior sagittal sinus is occluded; H, (right view) appearance of the head before surgery; I, (back view) repair scalp defects with flap transposition; J, (anterior view) appearance of the head after surgery, and flap heals well; K, extracranial tumor removed during surgery; L, postoperative CT shows that the tumor resection is satisfactory, the edema in the operation area was not obvious, and the shape of the skull repaired with titanium mesh is satisfactory. MRI, magnetic resonance imaging; CTA, computed tomography angiography; MRV, magnetic resonance venography; CT, computed tomography."