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.

Appliance of 3D-CT venography for the preoperative evaluation of parasagittal meningioma

Objective The authors investigated applying of3D-CTvenography (3D-CTV) to identify the superior sagittal sinus and parietal vein of Rolando for the preoperative surgerical plan for parasagittal and falx meningiomas. Methods A series of 11 consecutive patients with parasagittal and falx meningiomas were surgically treated in our department from June 2008 to February 2010. All patients underwent 3D-CTV preoperative to explore the involved superior saggitial sinus and important cortical drainage vein before operation.Result According to Simpson's scale, 9 procedures were Grade Ⅰ resection, 2 were Grade Ⅱ resection. The postoperative course was tncomplicated and all the patinets had satisfactory outcome on discharge. Among 11 patients with parasagittal meningiomas invading the sagittal sinus, 3D-CTV demonstrated the sagittal sinus were completely obstructed in 4 cases preoperative, which the radical resection of the tumor including the invaded part of sinus was made; 4 cases with meningiomas partial invading the sagittal sinus and the sintus still unobstructed demonstrated by 3D-CTV, which the radical resection of the tumor including the invaded wall of sinus was made and the sagittal sinus was reconstructed in 3 cases; 3 cases with meningiomas invading the lateral wall of the sagittal sinus demonstrated by 3D-CTV, which the resection of the tumor including the outer layer of the lateral wall of sinus was made in 1 case. There were no tumor recurrence at the last follow-up.Conclusions Comparing with MRV and DSA, 3D-CTV can examine the parasagittal meningiomas including the involved sagittal sinus and cortical drainage vein more easily and exactly, and it should be performed and scrutinized carefully before planning the surgical treatment for the parasagittal meningiomas.