Sindou and Alvernia et al. classified paraganglioma of the superior sagittal sinus into grade VI according to the degree of involvement of the superior sagittal sinus, with grade VI being complete occlusion of the superior sagittal sinus by the tumor. In cases of complete or near occlusion of the superior sagittal sinus, increased intracranial pressure (ICP) occurs due to obstruction of venous return, resulting in increased cerebral venous pressure and obstruction of cerebrospinal fluid reabsorption, particularly in parasagittal meningiomas of the posterior 1/3 segment of the superior sagittal sinus.Ashish H. Shah et al. reported in the December 2015 issue of J Neurosurg online four cases of posterior 1/3 that developed high cranial pressure paraganglioma of the superior sagittal sinus. Case 1: A 43-year-old female patient was admitted with spontaneous cerebrospinal fluid ear leak with mild headache, and MRI revealed a parasagittal sinus meningioma near the sinus confluence. The patient was treated by an otolaryngologist for cerebrospinal fluid ear leak repair, and the cerebrospinal fluid leak reoccurred after surgery. A lumbar puncture showed a significant increase in ICP up to 25 cm H2O, so a ventriculoperitoneal shunt was performed to relieve the cerebrospinal fluid leak and reduce intracranial pressure, followed by meningioma resection. After surgery, the patient’s wound healed well and the cerebrospinal fluid ear leak was cured. Preoperative MRI examination of patient in case 1. The left image is an MRI-T1 enhanced image showing a posterior parasagittal meningioma of the sagittal sinus; the right image is an MRV angiogram showing near total obstruction of the superior sagittal sinus (indicated by the arrow). Case 2: A 62-year-old male patient complained of headache with visual impairment for more than 1 year. MRI revealed a giant meningioma in the occipital region with severe invasion of the posterior superior sagittal sinus. The patient was given an occipital craniotomy, and the operation went smoothly with no intraoperative complications. However, postoperative cerebrospinal fluid leak occurred, so lumbar pool drainage was performed, and ICP was detected as high as 20 cm H2O. Since ICP remained high, lumbar pool abdominal shunt was performed instead. After surgery, the patient’s wound healed and his visual status gradually improved. Case 2 patient MRI examination, the left image is MRI horizontal T1-enhanced image and the right image is MRI coronal-enhanced scan image, showing a meningioma of 4.5cm×3.5cm in size in the posterior part of the superior sagittal sinus. Case 3: A 43-year-old male patient was admitted to the hospital with sudden onset of severe headache with left-sided isotropic hemianopia for 1 week. The imaging data showed a parsagittal meningioma in the right occipital area and the posterior part of the superior sagittal sinus was obstructed by the tumor. The patient was given a craniotomy in the right occipital area to remove the tumor, and the postoperative incision was split and there was cerebrospinal fluid leakage. The patient was given a lumbar pool cerebrospinal fluid drainage, and the initial pressure of ICP was monitored to be higher than 20 cm H2O. The drainage tube was removed after the ICP pressure decreased. The patient recovered well and no optic papillary edema was seen during the follow-up. Case 3: MRI of the patient. The left image is a sagittal T1-enhanced MRI image, and the right image is a horizontal-enhanced MRI image, showing a large meningioma involving the sinus sink in the posterior part of the superior sagittal sinus. Case 4: A 46-year-old female patient with progressive headache and numbness in the right lower extremity for several weeks had a paraganglioma in the posterior superior sagittal sinus of the left parietal lobe on cranial MRI. The preoperative lumbar puncture pressure was 28 cmH2O, and lumbar pool drainage was placed. A subtotal meningioma resection was performed and postoperative lumbar pool drainage was continued for 5 days, and the drainage tube was removed when ICP decreased and there was no cerebrospinal fluid incisional leakage. The patient was discharged without complications. MRI examination of patient 4, with MRI sagittal T1-enhanced image on the left and MRV on the right, showed a 2.4-cm-sized meningioma in the parietal lobe with stenosis or occlusion of the superior sagittal sinus. In summary, the authors concluded that the posterior 1/3 of the superior sagittal sinus was occluded by the meningioma, which blocked cerebral venous return and increased venous pressure, resulting in the symptoms of increased intracranial pressure with pseudotumor-like signs. Cerebrospinal fluid shunts are necessary to prevent a series of complications that occur after pseudotumor-like signs, including incisional dehiscence and cerebrospinal fluid leakage, even when it is difficult to reduce intracranial pressure even after resection of the tumor.