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。

Microsurgtcal treatment of large meningiomas in the sagittal sinus and faLx cerebri

Objective To probe into the pre-operative design and the operative approach dealing with anastomotic vein and superior sagittal sinus in patients with large meningiomas in the sagittal sinus and falx cerebri. Methods Thirty-five patients with large meningiomas in the sagittal sinus and falx cerebri, admitted to our hospital from January 2001 to December 2010, were chosen; their clinical data were analyzed retrospectively. The resection of the tumors by microsurgery (total or subtotal resection) was performed and intraoperative effective management of the sagittal sinus and falx cerebri was done. Results Resection was performed in these 35 patients, including Simpson grade Ⅰ in 21(60.0％), grade Ⅱ in 12 (34.2％), and grade Ⅲ in 2 (5.7％). Skull defect was noted in 5 patients. Unilateral　paralysis of limbs (muscle strength grade Ⅰ-Ⅳ) in 5; paralysis of both lower extremities (muscle strength grade Ⅰ-Ⅱ) in 1; good results were achieved after 1-6 months of hyperbaric oxygen, acupuncture and physiotherapy. During the follow-up period for 6 to 24 months, the tumor recurred in 2 with Simpson Ⅲstage resection (5.7％). Conclusion Designing a detailed pre-operative design according to the MRI,MRA, DSA and CTA, application of microsurgical techniques, avoidance of damage to the cerebral cortex and veins of central suleus and protection of the sagittal sinus are important factors that increase the success rate of surgical resection, reduce complications, prevent the tumor recurrence and improve the survival outcome in patients with parasagittal meningiomas.