双源CT静脉造影对上矢状窦旁脑膜瘤显微手术的价值探讨

目的 探讨脑双源CT静脉造影(CTV)显示上矢状窦旁脑膜瘤与上矢状窦关系、显示中央沟静脉和代偿回流静脉情况,从而为神经外科制定手术方案提供重要信息.方法 32例上矢状窦旁脑膜瘤患者行脑CTV检查,在工作站重建三维图像,术前判断肿瘤与静脉窦关系、显示中央沟静脉和代偿回流静脉并与术中情况对照.结果 根据CTV显示的窦腔狭窄程度,将上矢状窦旁脑膜瘤分为三型:Ⅰ型,瘤体与一侧静脉窦壁外层附着,静脉窦壁正常或轻度受压,窦腔通畅;Ⅱ型,肿瘤沿静脉窦壁生长,窦壁不规则增厚,窦腔变窄但尚通畅;Ⅲ型,瘤体长人静脉窦内或跨越生长,静脉窦腔内形成充盈缺损,窦腔闭塞,同时有静脉侧支循环建立.本组Ⅰ型8例,Ⅱ型15例,Ⅲ型9例.术中观察到代偿扩张的浅静脉以及肿瘤与中央沟静脉、上矢状窦的关系均与CTV结果相符.本组无术后严重神经功能受损和死亡病例.结论 上矢状窦旁脑膜瘤患者术前行CTV检查可以明确肿瘤部位、矢状窦阻塞程度及引流静脉代偿情况,为手术人路的选择及手术方案的制定提供重要信息,在全切肿瘤的同时减少并发症的发生,提高患者的生活质量.

Study on the value of double source CT venography in the microsurgical treatment of parasagittal meningiomas

Objective To explore the relationship between parasagittal meningiomas and superior sagittal sinus,and rolandie vein with double source CT venography.Methods CT scanning of 32 patients of parasagittal meningiomas in venous phase was carried out and 2D and 3D vascular images were gained through workstation.We observed the relationship between the tumor and vein on the CTV images and compared the appearance with the operation.Results The parasagittal meningiomas was divided into 3 types according to the narrow degree of the sinus.There was 8 cases of typeⅠ,15 cases of typeⅡ,9 cases of type Ⅲ in this group.The relationship between tumor and sinus was accord with the appearance of surgery.Conclusion CTV can reveal the location of the tumor,the narrow of the sinus and the draining vein,which can provide important message for the operation.CTV technique is able to acurately demonstrate relationship between the tumor and vein.It is not only helpful for the total removal of lesions but also for decreasing the postoperative complications.