上矢状窦旁中后1/3脑膜瘤术中回流静脉的保护

目的探讨上矢状窦旁中后1/3脑膜瘤术中如何保护回流静脉,以提高手术治疗效果。方法回顾性分析2002年11月至2010年12月应用回流静脉保护技术治疗上矢状窦旁中后1/3脑膜瘤42例,术前均行MRV检查,术中采取跨中线骨瓣,绕行剪开硬膜,妥善处理肿瘤与中央沟静脉粘连和受累的矢状窦。采取传统手术20例。结果采取回流静脉保护组回流静脉均保护完整,无神经功能障碍加重。传统手术组4例因术中回流静脉损伤而出现偏瘫、颅高压症状,1例行去骨瓣减压术,2例上肢遗留偏瘫。结论应用术前MRV检查和术中注意回流静脉的保护等显微技术切除上矢状窦旁中后1/3脑膜瘤可减少脑重要功能区的损伤,提高术后患者生存质量。     

中央区矢状窦旁脑膜瘤显微手术及中央沟静脉保护(16例报告)

矢状窦旁脑膜瘤是颅内常见脑膜瘤之一, 而位于中央区附近的窦旁脑膜瘤,因常常累及矢状窦以及中央沟静脉等引流静脉,且术中易导致中央沟静脉损伤而导致术后肢体瘫痪等并发症,严重影响患者的生活质量.所以,在全切除肿瘤的基础上,重视对中央沟静脉及重要引流静脉的保护显得尤为重要.2006年10月~2010年6月,我科采用显微手术切除中央区矢状窦旁脑膜瘤16例,术中注意了对中央沟静脉的保护,效果良好.现报告如下.     

磁共振静脉成像对矢状窦旁脑膜瘤的术前评估

目的 探讨磁共振静脉成像(MRV)在矢状窦旁脑膜瘤术前评估中的作用.方法 对经MRI平扫和增强扫描诊断为矢状窦旁脑膜瘤的患者行MRV及DSA检查.分别记录两种影像资料中肿瘤侵犯静脉窦的部位、静脉窦通畅程度及矢状窦旁脑膜瘤相关侧枝静脉吻合的显示情况并进行比较分析.结果 29例矢状窦旁脑膜瘤患者中,MRV对矢状窦受侵部位的显示与DSA和术中所见一致;对上矢状窦受侵犯通畅程度的显示上,MRV诊断矢状窦通畅的敏感度是87.0％,特异度是66.7％,符合率为82.8％.MRV对矢状窦旁脑膜瘤相关侧枝静脉吻合显示的敏感度是25.0％,特异度是76.9％,符合率为48.3％.结论 MRV在窦旁脑膜瘤侵犯静脉窦的部位、通畅程度上为其术前评估提供参考依据.     

显微手术切除矢状窦旁脑膜瘤(附35例报告)

目的探讨矢状窦旁脑膜瘤的诊断和治疗方法.方法根据肿瘤的临床特点,术前行CT 、MR、血管造影检查,使用显微手术,根据肿瘤大小,位置决定整块或分块切除,术中妥善处理供血动脉,保护矢状窦及中央静脉,以避免不良后果.结果本组主要表现为大脑半球损害的症状和体征,经MR确诊后均行手术治疗.肿瘤全切除33例,次全切除2例.因2例术中未能保留中央静脉而造成偏瘫,2例因脑血管病、肺炎死亡.余31例恢复良好.门诊随访2～6年无复发.结论矢状窦旁脑膜瘤行CT、MRI检查可明确诊断,显微手术是最佳的治疗方法,切除肿瘤避免功能区损伤是取得手术成功的关键.     

纵裂入路切除双侧窦镰旁脑膜瘤

目的 探讨纵裂入路显微切除双侧窦镰旁脑膜瘤的手术方法 ,分析该术式的影响因素.方法 应用纵裂入路显微切除双侧窦镰旁脑膜瘤21例,同时处理受累的矢状窦及大脑镰,并对手术的方法 及效果进行分析.结果 Simpson I级切除2例、Ⅱ级切除13例,Ⅲ级4例,Ⅳ级2例.结论 纵裂入路显微切除双侧窦镰旁脑膜瘤,手术路径短,暴露空间大,周围结构保护良好.肿瘤切除程度取决于肿瘤与矢状窦、胼周动脉、胼缘动脉、中央沟、上引流静脉等结构的关系.     

大脑镰及矢状窦旁脑膜瘤术中静脉系统保护的探讨

目的 探讨大脑镰及矢状窦旁脑膜瘤术中静脉系统保护的临床意义.方法 回顾性分析34例采用手术切除的大脑镰及矢状窦旁脑膜瘤病人的临床资料,总结处理瘤周侧支静脉和受累矢状窦的经验.结果 手术切除上矢状窦前段1例,明胶海绵+耳脑胶修补破损窦壁5例,电灼侧壁23例.按Simpson切除分级:Ⅰ级切除26例,Ⅱ～Ⅲ级切除8例.随访34例,时间6个月～5年.无相关静脉损伤后并发症.结论 术前通过静脉血管造影明确瘤周侧支静脉及上矢状窦受累程度,有助于大脑镰及矢状窦旁脑膜瘤术中对静脉系统的保护,减少术后并发症.     

中央沟区矢状窦旁脑膜瘤的显微手术治疗（附25例报告）

目的 探讨显微手术治疗中央沟区矢状窦旁脑膜瘤的疗效。方法 对25例经显微手术治疗的中央沟区矢状窦旁脑膜瘤的临床资料进行回顾性分析。结果 肿瘤Simpson Ⅰ级切除6例,Ⅱ级16例,Ⅲ级3例;术后加行伽玛刀治疗3例。术后3个月按脑肿瘤切除病人生活质量分级评价手术效果:Ⅰ级18例,Ⅱ级5例,Ⅲ级2例。术后平均随访26个月,无复发。结论 显微手术治疗中央沟区矢状窦旁脑膜瘤,术前做好周密的手术计划、术中有效地控制出血、保护好中央沟区的动静脉和脑组织、处理好肿瘤与上矢状窦的关系、根据术前的水肿程度及术中实际情况合理还纳骨瓣,再辅以良好的术后管理,将会获得满意的效果。     

显微手术治疗窦镰旁脑膜瘤的疗效

目的 探讨显微手术切除矢状窦、大脑镰旁脑膜瘤的疗效。方法 回顾性分析手术治疗的46例矢状窦、大脑镰旁脑膜瘤的临床资料,其中矢状窦前1/3段 13例,中1/3 29例,后1/3 4例;肿瘤基底位于矢状窦16例,大脑镰22例,矢状窦和大脑镰同时受累8例。结果 肿瘤SimpsonⅠ级切除32例,Ⅱ级切除9例,Ⅲ级切除4例,Ⅳ级切除1例。41例术后随访1~5年,肿瘤复发3例,行放射治疗2例,再手术1例。结论 良好的手术显露,矢状窦及引流静脉的妥善保护和处理是提高矢状窦旁、大脑镰脑膜瘤手术疗效的重要因素。     

皮质中央区矢状窦旁镰旁脑膜瘤的显微外科治疗

目的探讨皮质中央区矢状窦旁大脑镰旁脑膜瘤的手术方法和治疗效果。方法对手术治疗的35例皮质中央区矢状窦旁大脑镰旁脑膜瘤患者的影像学资料、手术入路、显微手术切除肿瘤的方法及策略进行回顾性分析。结果按Simpson切除标准,Ⅰ级切除24例(68.6%),Ⅱ级切除11例(31.4%)。无手术死亡。随访3个月至5年,4例复发,行二次手术。结论充分的术前影像学评估,合适的手术入路,术中保护好中央沟静脉、处理好上矢状窦和避免脑皮质的损伤,细致的显微操作,能明显提高肿瘤的全切除率,降低复发和其他并发症。     

中央沟区矢状窦旁脑膜瘤手术治疗的临床分析

目的探讨中央沟区矢状窦旁脑膜瘤的显微手术治疗方法及效果。方法回顾性分析32例采用显微手术切除的中央沟区矢状窦旁脑膜瘤病人的临床资料。结果 SimpsonⅠ级切除3例,SimpsonⅡ级切除15例,SimpsonⅣ级切除14例。无手术死亡病例。无新增癫疒间发作。术后运动障碍改善14例,感觉障碍改善9例。严重脑水肿和梗死1例,去骨瓣加压术后恢复良好。随访6个月~7年,平均45个月,复发6例(SimpsonⅡ级切除2例和Ⅳ级切除4例),其中2例再次手术治疗。结论术前充分评估,术中合理处理回流静脉、中央沟静脉和上矢状窦,尽可能避免毗邻脑组织的再损伤是提高手术效果和改善生活质量的重要手段,不应过分追求肿瘤全切。     

Surgical treatment of parasagittal and falx meningiomas

BACKGROUND AND PURPOSE: We present our experience with surgery of parasagittal and falx meningiomas with special consideration of surgical outcome and risk of recurrence. MATERIAL AND METHODS: A series of 87 consecutive patients surgically treated for parasagittal and falx meningiomas is reported. 50 patients had parasagittal meningiomas and a further 37 had falx meningiomas. Meningioma invaded the superior sagittal sinus in 21 cases. According to Simpson's scale, 25 procedures were Grade I resection, 55 were Grade II resection and 7 were Grade IV resection. Among 21 patients with parasagittal meningiomas invading the sagittal sinus, radical resection of the tumour and invaded part of sinus was made in 9 cases. RESULTS: Seven patients were severely disabled and 4 patients died after the surgery whereas 76 patients had satisfactory outcome on discharge. At the time of analysis, 14 patients had shown evidence of recurrence. Male gender, partial removal of meningioma (Simpson Grade IV) and bilateral falx meningioma had a statistically significant influence on recurrence. There were no tumour recurrences following radical resection of the tumour and invaded part of sinus, but two postoperative deaths due to haemodynamic complications were noted. In the other 12 patients, meningiomas were removed but sinus infiltration was left in place; the postoperative period was uneventful but the rate of clinically important regrowth in this group of patients was 25% in long-term follow-up. CONCLUSIONS: Rate of recurrence of parasagittal and falx meningioma significantly increases in cases of non-radical resection of tumour. Aggressive surgical treatment presents several hazards and carries an increased risk of unsatisfactory outcome; the risk of recurrence, however, is significantly decreased.     

大脑镰及矢状窦旁脑膜瘤显微手术治疗的研究

目的探讨大脑镰及矢状窦旁脑膜瘤显微手术的方法及效果。方法回顾性分析47例大脑镰及矢状窦旁脑膜瘤患者的临床资料,术前影像学检查显示肿瘤位于矢状窦前1/3者27例,中1/3者11例,后1/3者9例,肿瘤最大径4~8 cm,47例患者均行显微手术治疗。结果按照切除程度划分,SimpsonⅠ级切除25例,Ⅱ级切除17例,Ⅲ级切除5例。随访时间6~49个月,SimpsonⅠ级切除的25例患者均无复发;22例SimpsonⅡ~Ⅲ级切除患者中,共有3例患者复发,均再次手术治疗。无手术死亡病例。结论术中对回流静脉、侧支静脉及静脉窦的保护,尽可能全切除或次全切除肿瘤,可以有效提高大脑镰及矢状窦旁脑膜瘤显微手术治疗的效果。     

矢状窦、镰旁巨大脑膜瘤的显微外科治疗

目的探讨上矢状窭、镰旁巨大脑膜瘤的术前设计及术中处理上吻合静脉、上矢状窦的方法,提高矢状窦、镰旁巨大脑膜瘤的手术疗效。 方法回顾性分析南昌大学第二附属医院神经外科自2001年1月至2010年12月收治的35例矢状窦、镰旁巨大脑膜瘤患者的临床资料,患者均经充分的术前准备并设计较详细的手术方案,行显微手术全切或次全切除术,术中对受累的上吻合静脉、上矢状窦、硬脑膜及颅骨做相应的处理。 结果35例患者中肿瘤切除达到Simpson Ⅰ级21例,SimpsonⅡ级12例,SimpsonⅢ级2例。术后遗留颅骨缺损5例;单侧肢体瘫痪（肌力Ⅰ～Ⅳ级）5例,双下肢瘫痪（肌力Ⅰ～Ⅱ级）1例,经高压氧、针灸理疗等综合治疗1～6个月后均恢复正常。随访6～24个月,SimpsonⅢ级切除者2例复发。 结论通过术前充分的MRI、MRA、DSA、CTA等影像学评估及设计较详细的手术方案,术中采用显微外科技术、有效地控制出血、妥善处理好上矢状窦及受累的上吻合静脉、避免正常脑组织医源性损伤、尽可能全切或次全切除肿瘤,是提高矢状窦、镰旁巨大脑膜瘤手术疗效的重要因素。     

Surgical treatment of parasagittal and falcine meningiomas invading the superior sagittal sinus

ObjectiveWe present our experience with surgery of parasagittal and falcine meningiomas invading the superior sagittal sinus with special consideration of the surgical complications and the incidence of tumour recurrence.Materials and methodsThe analysis included 37 patients with parasagittal and falcine meningiomas invading the superior sagittal sinus. In 13 cases, the sinus was ligated and resected with tumour. In 14 cases, the sinus was entered with the goal of tumour resection and the sinus was reconstructed, while in 10 patients the sinus was not entered and the remaining residual tumour was observed for growth.ResultsOut of 13 patients after radical resection of the tumour and invaded part of sinus, 9 revealed haemodynamic complications: venous infarction (4), significant brain oedema (3) and hypoperfusion syndrome (2). 2 out of 14 patients after resection of the tumour from the lumen of the superior sagittal sinus with subsequent sinus repair developed venous infarction after surgery. Among 27 patients after radical tumour excision the remote follow-up revealed recurrence in 2 patients. There were no significant haemodynamic complications in none of 10 cases, in which the residual tumour was left after surgery in the superior sagittal sinus. In this group, 3 cases were subjected to early post-operative radiotherapy and local recurrence was observed in 4 patients.ConclusionsThe aggressive surgical treatment of meningiomas infiltrating the superior sagittal sinus is associated with a high surgical risk. The incidence of recurrence of these tumours increases significantly in the case of non-radical excision of the tumour.     

镰旁脑膜瘤显微手术策略

目的介绍镰旁脑膜瘤分型及据此采用的显微手术治疗方法。方法根据冠状位MRI成像将镰旁脑膜瘤分为3型,Ⅰ型,肿瘤位于大脑镰的一侧,大脑镰本身没有移位或肿瘤靠近上矢状窦;Ⅱ型,肿瘤位于大脑镰的一侧,大脑镰局部明显向对侧移位;Ⅲ型,肿瘤向大脑镰两侧生长,两侧等大或不等大。Ⅰ型采用同侧、Ⅱ型采用对侧、Ⅲ型采用瘤体较小侧或非优势半球侧纵裂入路显微手术切除肿瘤。结果显微手术治疗镰旁脑膜瘤20例,均全切除肿瘤,无严重并发症及手术死亡。结论根据肿瘤不同生长方式选择肿瘤同侧或对侧纵裂入路显微手术治疗镰旁脑膜瘤比较合理。     

Occlusion of the superior sagittal sinus caused by meningioma, intracranial volume-pressure relations and brain edema]

Fifty-one cases of parasagittal meningiomas were analysed. In 37 cases the tumour was situated in the middle and posterior part of the falx. In 17 cases occlusion of the superior sagittal sinus was diagnosed and confirmed by angiography. No correlation was found between the extent of brain oedema and sinus occlusion and tumour size. However, extensive oedema was present in tumours of high malignancy. Occlusion of the sagittal sinus caused no increase of intracranial pressure or venous stasis. This suggests that sinus occlusion caused by meningioma is completely compensated and has no effect on the preoperative and postoperative course.     

上矢状窦旁脑膜瘤致上矢状窦阻塞时侧支静脉通路的意义

目的 分析上矢状窦旁脑膜瘤致上矢状窦(SSS)阻塞时其侧支静脉通路的建立情况，确定其在肿瘤切除术中的意义。方法 总结归纳86例上矢状窦旁脑膜瘤行MRA及DSA检查时的静脉系表现。结果 27例发生SSS完全阻塞，59例部分阻塞。18例在阻塞的SSS周围出现了由表浅皮层静脉所形成的侧支静脉环；通过表浅皮层静脉与蝶顶窦及小脑幕静脉系建立端—端吻合的16例；通过与Troland或Labbe静脉建立吻合的14例；通过大脑镰与下矢状窦吻合的9例；通过脑膜静脉并经板障静脉引流到颈外静脉系的17例；混合型12例。结论 上矢状窦旁脑膜瘤致SSS阻塞时，肿瘤周围存在广泛侧支静脉通路，术中应注意保护。脑DSA及MRA检查对术前了解SSS通畅性及侧支静脉通路建立有帮助。     

Bilateral basal ganglia infarction following resection of a right parietal parasagittal dural tumour requiring sinus repair -- an atypical complication of an atypical venous drainage

The case of a 68-year old woman who underwent surgery for a right parietal parasagittal dural tumour is reported. In the preoperative angiography the straight sinus failed to show. During tumour resection the lateral wall of the parietal superior sagittal sinus was opened and reconstructed. Postoperatively, the patient remained unresponsive. A computerized tomography scan revealed bilateral infarction of the basal ganglia. Angiography showed an occlusion of the superior sagittal sinus with hypervolaemia of the deep venous system. The patient did not recover. We conclude that patency of the superficial venous drainage system can be mandatory for drainage of the basal ganglia in cases with deep venous obstruction. To our knowledge, this is an extremely rare complication of neurosurgery in cortical supratentorial areas.     

大型矢状窦旁脑膜瘤显微外科治疗

目的探讨显微外科技术在大型矢状窦旁脑膜瘤手术中的应用。方法肿瘤位于矢状窦前1/3有6例,中1/3有13例,后1/3有8例;其中跨上矢状窦两侧的有2例,颅骨侵犯的2例,软组织侵犯的1例合并有肿瘤卒中。采用跨中线骨瓣,显微手术技术切除27例上矢状窦旁大型脑膜瘤。结果肿瘤SimpsonⅠ级16例,SimpsonⅡ级8例,SimpsonⅢ级3例;术后回访3~36个月,1例术后二个月复发。结论采用显微外科技术,暴露上矢状窦,充分显露肿瘤,有效控制出血,保护回流静脉,可减少并发症。