侵犯上矢状窦脑膜瘤的显微手术治疗

目的探讨侵犯上矢状窦脑膜瘤的手术治疗方法。方法回顾性分析黄山市人民医院神经外科2003年12月-2011年10月收治的侵犯上矢状窦的脑膜瘤患者,共14例,男性8例、女性6例,年龄34～63岁,平均49岁。颅内压增高者9例,癫痫发作3例,偏瘫等定位体征4例。肿瘤部位均为单侧。对14例患者采用显微手术切除,同时行受累上矢状窦壁切除加重建上矢状窦11例,受累上矢状窦部切除3例。结果 14例患者手术结果满意,术后恢复良好,无死亡病例。9例颅内压增高患者,术后头痛、呕吐等症状消失,3例癫痫患者术后癫痫发作缓解,4例术前偏瘫等定位体征患者,术后阳性体征明显改善或恢复正常。所有患者随访6个月～5年,1例患者术后脑膜瘤复发,行二次手术治愈,其余13例均未见复发。结论采用显微外科技术行上矢状窦旁脑膜瘤镜下全切除,同时行受累矢状窦切除,或上矢状窦壁切除加重建上矢状窦,可有效治疗侵犯上矢状窦的窦旁脑膜瘤。

Microsurgical Treatment of Parasagittal Meningioma with Invaded Superior Sagittal Sinus

Objective To explore the surgical treatment strategy of parasagittal meningioma invading superior sagittal sinus.Methods The clinical data of 14 patients with parasagittal meningioma invading the superior sagittal sinus from December 2003 to October 2011 in department of neurosurgery were analyzed retrospectively.8 cases were male,6 cases were female,the average age was 49(34-63 years old).9 cases were with intracranial pressure heighten symptoms,3 with epilepsy and 4 with hemiplegia positioning signs.Tumor site were unilateral.14 cases of parasagittal meningioma with the superior sagittal sinus invaded were treated by microsurgical resection.In 11 cases the wall of the tumor invaded superior sagittal sinus was removed and reestablished.In 3 cases the tumor invaded superior sagittal sinus was segmental resected.Results The operation and postoperative recovery of the 14 patients was satisfactory,no deaths.9 patients with intracranial pressure heighten,the postoperative symptoms were disappeared such as headache and vomiting,3 with epilepsy was alleviated,4 with hemiplegia positioning signs,the postoperative signs was significantly improved or returned to normal.All patients were followed up for 6 months to 5 years,1 case had the meningioma recurrence,and cured by reoperation,the rest 13 cases were not found recurrence.Conclusion The microscopically complete resection of the parasagittal meningioma,and segmental resect the tumor invaded superior sagittal sinus or remove and reestablish the wall of the invaded superior sagittal sinus at the same time using microsurgical technique could effectively treat parasagittal meningioma with the superior sagittal sinus invaded and improve outcomes of the patients.