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。

Protection of draining vein during operation on parasagittal meningiomas in the middle and posterior 1 / 3 of sagittal sinus

Objective To evaluate the techniques for protection of draining vein and improve surgical effects of operation on parasagittal meningiomas in the Middle and posterior 1/3 of sagittal sinus.Methods Forty-two cases of parasagittal meningiomas in the Middle and posterior 1/3 of sagittal sinus receiving the techniques for protection of draining vein were analyzed retrospectively from Nov 2002 to Dec 2010.Twenty patients receiving traditional operation served as controls.MRV scan was performed in all patients before operation.Techniques for protection of draining vein such as cutting dura circumambiently and midline craniotomy were used to treat adhesion between rolandic vein and the involved sagittal sinus appropriately.Results Draining vein was well protected and no neurological deficit was found in patients receiving the techniques for protection of draining vein.In contrast,four cases in traditional operation group developed hemiparalysis and symptoms of increased intracranial pressure due to draining vein injury.One of them had to undergo further decompressive craniectomy and 2 cases left with hemiparalysis of upper extremity.Conclusions MRV pre-operation scan and the use of microsurgical techniques for protection of draining vein in the resection of the parasagittal meningiomas in the middle and posterior 1/3 of sagittal sinus may decrease the damage to important functional area of the brain and improve survival quality.