显微手术切除脑中央区双侧镰旁巨大脑膜瘤

目的 探讨显微外科技术在脑中央区双侧镰旁巨大脑膜瘤手术中的应用.方法 采用跨中线骨瓣、条状硬脑膜瓣、向对侧牵引上矢状窦和经单侧纵裂切除双侧肿瘤等显微手术技术,切除16例脑中央区双侧镰旁巨大脑膜瘤.结果 肿瘤均为Simpson I级切除,术后症状较术前改善13例,与术前相同3例,无手术死亡;术后随访6个月-5年,全部患者均未见肿瘤复发.结论 应用显微外科技术能够较好地避免过度牵拉脑叶,减少功能区脑皮层和重要回流静脉的损伤,消除了上矢状窦对大脑镰的"屋檐效应",有利于肿瘤的暴露和完全切除.     

显微手术切除脑中央区双侧镰旁巨大脑膜瘤

目的 探讨显微外科技术在脑中央区双侧镰旁巨大脑膜瘤手术中的应用.方法 采用跨中线骨瓣、条状硬脑膜瓣、向对侧牵引上矢状窦和经单侧纵裂切除双侧肿瘤等显微手术技术,切除16例脑中央区双侧镰旁巨大脑膜瘤.结果 肿瘤均为Simpson I级切除,术后症状较术前改善13例,与术前相同3例,无手术死亡;术后随访6个月-5年,全部患者均未见肿瘤复发.结论 应用显微外科技术能够较好地避免过度牵拉脑叶,减少功能区脑皮层和重要回流静脉的损伤,消除了上矢状窦对大脑镰的"屋檐效应",有利于肿瘤的暴露和完全切除.

Abstract：

Objective To investigate microsurgical techniques in bilateral falcine meningiomas of central gyrus region surgery. Methods Sixteen patients with bilateral falcine meningiomas in central gyrus region were treateded with a series of microsurgical techniques, including midline - crossing craniotomy,dural cut in a strip fashion with a flap based on the superior sagittal sinus, retraction of the superior sagittal sinus toward the opposite side and an ipsilateral interhemispheric fissure approach. The clinical data and prognosis was summarized. Results Simpson I grade removal was achieved in all patients. The neurological functions were improved in 13 cases, unchanged in 3 cases postoperatively. There was no postoperative death. The follow up period of patients ranged from 6 to 60 months and no tumor recurrence was observed. Conclusion Application of minimally microsurgical techniques can be better to avoid over -stretch the brain leaves, reduce significant damage to eloquent cerebral cortex as well as venous reflux,and eliminate the "eaves effect" of the superior sagittal sinus to the falx in favor of exposure and complete resection of tumor.     

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。     

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.     

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。     

大脑镰及矢状窦旁脑膜瘤的显微手术治疗

目的探讨大脑镰及矢状窦旁脑膜瘤显微手术方法和疗效。方法回顾性分析34例大脑镰及矢状窦旁脑膜瘤患者的临床资料,34例患者均行显微手术治疗。结果脑膜瘤切除程度按Simpson分级:Ⅰ级切除26例,Ⅱ~Ⅲ级切除8例。术后随访0.5~5年,22例患者感觉或运动障碍均有不同程度的恢复;8例癫痫患者中6例癫痫未再发作;复发1例,再次行手术治疗。结论采用显微外科技术,有效保护重要引流静脉、侧副静脉及静脉窦,尽可能全切除或次全切除肿瘤,是提高大脑镰及矢状窦脑膜瘤手术疗效的重要因素。     

15例大脑镰旁双侧脑膜瘤的显微手术治疗体会

目的探讨大脑镰旁双侧脑膜瘤的显微外科手术治疗。方法对15例大脑镰双侧旁脑膜瘤均行手术治疗，对于肿瘤位于矢状窦前1／3者结扎矢状窦，中、后1／3者显微镜下双侧剪开硬脑膜，分次囊内切除肿瘤，最后连同大脑镰一并切除。结果按Simpson脑膜瘤切除分级：Ⅰ级9例，Ⅱ级5例，Ⅲ1例，其中1例术后出现肢体瘫痪。随访3年，均未复发。结论选择合适的显微外科技术和方法，术中最大限度地减小回流静脉的损伤和脑组织的牵拉，尽量全切除肿瘤，可达到满意临床效果。     

矢状窦、大脑镰旁脑膜瘤的显微手术治疗

目的探讨纵显微手术切除矢状窦、大脑窦镰旁脑膜瘤的手术方法和疗效。方法回顾分析经显微手术治疗的31例矢状窦、大脑窦镰旁脑膜瘤患者的临床资料。结果 SimpsonⅠ级切除20例,Ⅱ级切除7例,Ⅲ级切除2例,Ⅳ级切除2例。29例随访6个月至5年,13例不全性偏瘫者完全恢复,8例术前偏侧感觉障碍者均不同程度改善,4例术前上矢状窦局部完全闭塞者术后3年无复发,4例肿瘤双侧对称生长者双侧开颅术后5年无复发。2例失访。无死亡病例。结论认真分析术前影像资料,熟练运用显微外科技术,有效控制术中出血,保护中央区和上引流静脉,妥善处理受累上矢状窦,可以明显提高肿瘤全切率,减少并发症。     

中央区窦/镰旁脑膜瘤的显微手术治疗

<正>大脑镰及矢状窦旁是脑膜瘤好发部位[1,2],中央区巨大肿瘤常侵犯上矢状窦或中央沟静脉,使其部分或完全闭塞,与下矢状窦、皮层静脉及重要皮层关系密切,增加了全切肿瘤的难度,是否必须全切与重建矢状窦仍存争议[3]。我院于2003年7月2012年12月共收治中央区矢状窦镰旁脑膜瘤30例,显微外科手术治疗情况,报告如下。     

复发高级别矢状窦旁脑膜瘤的显微外科手术治疗

目的探讨显微外科治疗复发高级别矢状窦旁脑膜瘤的临床疗效,并进一步总结此类肿瘤的治疗经验。方法回顾性分析8例显微外科手术切除的复发高级别矢状窦旁脑膜瘤(WHOⅡ和Ⅲ级)病人的临床资料。6例肿瘤侵犯矢状窦腔和矢状窦壁的病人中,5例矢状窦未完全闭塞;余2例仅侵犯矢状窦壁和大脑镰。结果肿瘤切除程度:侵犯矢状窦腔和矢状窦壁的6例,其中SimpsonⅡ级切除4例,Ⅲ级切除2例;侵犯矢状窦壁和大脑镰的2例,其中SimpsonⅠ级切除1例,Ⅱ级切除1例。术后病理:不典型脑膜瘤4例(WHOⅡ级),脊索样脑膜瘤1例(WHOⅡ级),横纹肌样脑膜瘤1例(WHOⅢ级),间变型脑膜瘤2例(WHOⅢ级)。1例间变型脑膜瘤术后2个月死于脑脊液感染,余7例行常规放射治疗。随访7例,时间4～48个月,复发1例,偏瘫2例,余4例恢复良好。结论显微手术切除复发高级别矢状窦旁脑膜瘤可取得良好疗效,术前需做好周密的手术计划,术中应用神经电生理监测技术保护好与复发肿瘤明显黏连的引流静脉和脑组织,处理好肿瘤与上矢状窦的关系。     

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。     

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.     

Surgical management of falcine meningiomas: Experience of 95 patients

Falcine meningiomas, defined as a meningiomas arising from the falx not involving the superior sagittal sinus, account for 9% of all intracranial meningiomas. We analyzed 95 patients with falcine meningiomas who underwent surgical removal of their lesion at our institution between 2001 and 2014. Surgical management of these patients, focusing on anatomical and clinical features is described. Thus, based on our series, a surgical algorithm, classifying the falcine meningioma into four types, according to location at the falx, and using an ipsilateral interhemispheric approach in supine or prone position, is described. The median length of follow-up was 7.1 years (range 1.6–12.3 years). Approximately one-third of all patients was asymptomatic, headaches occurred in 27 patients, seizures in 14 cases, and lower-extremity weakness in 9 cases. In this series, the middle third of the falx was the most frequently involved site (55,78%), while the anterior third (26,31%) and the posterior type (17,89%) were less common. The transitional and meningothelial types occurred in 69 of patients and a high grade in only two patients. Compared with previous series in literature, there was no mortality and Gross Total Resection was obtained in 83 (87,5%) cases. Three of 95 patients experienced new or worsened neurological deficits after surgery while other complications were relatively in only 6 cases. This study presents our good results about removal of the tumor while preserving major cortical veins and the sinus using advanced microsurgical tools.     

3D-CT静脉造影对矢状窦旁脑膜瘤的术前评估

目的 通过3D-CT静脉造影(3D-CTV)来判断矢状窦旁脑膜瘤与矢状窦、肿瘤周围皮层回流静脉的关系,为制定手术方案提供帮助.方法 2008年6月至2010年2月收治11例矢状窦旁脑膜瘤患者术前接受3D-CTV检查,3例同时MRV检查.通过观察3D-CTV中肿瘤与所累矢状窦及周边中央沟静脉、中央前沟静脉之间的关系;术前判断矢状窦的通畅性,并根据术中实际情况来验证3D-CTV结果的准确性.结果 11例矢状窦旁脑膜瘤患者术前3D-CTV检查发现:4例位于额叶矢状窦旁脑膜瘤上矢状窦已经完全被肿瘤侵犯包裹而闭塞,手术将肿瘤包括累及矢状窦一并切除;4例额顶脑膜瘤部分侵入上矢状窦,上矢状窦仍然通畅,其中3例手术将累及上矢状窦侧壁及侵入窦内肿瘤一并切除,同时修补上矢状窦,另1例行肿瘤切除加累及的上矢状窦侧壁电凝烧灼;3例额顶脑膜瘤仅累及上矢状窦侧壁而没有侵入至窦内,1例手术将肿瘤连同矢状窦侧壁外层一并切除,2例行肿瘤加受累及矢状窦侧壁电凝.5例患者3D-CTV同时清晰显示肿瘤与周围中央沟静脉、中央前沟静脉之间关系密切,1例患者中央前沟静脉术中有损伤,其余患者静脉均保护完好.9例矢状窦旁脑膜瘤获得Simpson Ⅰ级全切除,2例Simpson Ⅱ级全切除,术后患者恢复良好,随访未见肿瘤复发.结论 3D-CTV所显示肿瘤与矢状窦关系与手术实际情况吻合.相对于MRV和DSA,通过3D-CTV检查可更方便、直观地判断矢状窦旁脑膜瘤与矢状窦及肿瘤周边静脉的关系,对于矢状窦旁脑膜瘤术前行3D-CTV检查,可为手术方案的制定提供帮助.     

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。     

中央回区脑膜瘤的显微外科治疗

目的 探讨中央回区脑膜瘤的手术方法和技巧.方法 回顾性分析采用显微外科手术切除15例中央回区脑膜瘤的临床资料,其中肿瘤位于中央前回8例,中央后回5例,中央前后回均受累2例.结果 Simpson Ⅰ级切除9例,Ⅱ级切除5例,Ⅲ级切除1例.无手术死亡,术后功能障碍好转10例,无效5例,新增短期功能障碍6例;随访9-38个月,未见肿瘤复发.结论 中央回区脑膜瘤应在良好功能保护的前提下,力争达到Simpson Ⅰ级切除.准确定位、保护好功能区皮质、加强回流静脉结构和功能的维护是降低中央回区脑膜瘤手术残障率的关键.     

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。