中央区窦镰旁大型脑膜瘤的显微外科治疗

Microsurgical treatment of large parasagittal and parafalx meningiomas in the middle cortex area

摘要:

目的探讨显微外科治疗中央区窦镰旁脑膜瘤的临床疗效，并进一步总结该病的显微外科治疗经验及体会。方法回顾性分析我科2010~2015年40例中央区窦镰旁大型脑膜瘤患者的临床资料。结果术后按照Simpson分级 40例患者其中位于中央区侵犯大脑镰及矢状窦壁者22例行Simpson I级切除16例，Simpson II级切除6例；位于中央区侵犯大脑镰及矢状窦腔者6例行Simpson I级切除4例（肿瘤致窦腔完全闭塞），Simpson IV级切除2例（肿瘤未使窦腔完全闭塞）；位于中央区皮层深部只侵犯大脑镰者5例均为Simpson I级切除；位于中央区皮层凸面只侵犯矢状窦者7例，其中只侵及窦壁者5例Simpson I级切除3例，Simpson II级切除2例，侵入窦腔者2例均行Simpson IV级切除。以上40例患者随访3个月至5年，Simpson I级切除的28例患者均无复发；Simpson II级切除8例者其中7例无复发，1例随访半年后肿瘤复发，予以伽马刀治疗后肿瘤消失；Simpson IV级切除4例随访1年后肿瘤均有所增长，均予以伽马刀治疗，之后失访。术后出现偏瘫者10例，随访1年后完全恢复者6例，4例部分恢复。无死亡病例。结论静脉窦等的血管影像及熟练的显微外科技术能有效地保护功能区皮层结构及回流静脉，从而减少术中出血，提高全切率，降低致残及复发率，避免死亡。

关键词:窦镰旁脑膜瘤|中央区|头部MRV|显微外科手术

Abstract:

Abstract:ObjectiveTo investigate the clinical outcome of microsurgery for parasagittal and parafalx meningioma in the middle cortex area, and summarize our surgical experience.MethodsClinical data of 40 patients with large parasagittal and parafalx meningioma in the middle cortex area hospitalized in our department from 2010 to 2015 were analyzed retrospectively.ResultsThe tumors were located in the middle cortex area, invading both the cerebral flax and sagittal sinus wall in 22 cases. Of them, Simpson grade I resection was achieved in 16 cases, and Simpson grade II resection in 6. Tumors were located in the middle cortex area and invaded cerebral flax and sagittal sinus cavity in 6. Of them, Simpson grade I resection was achieved in 4 cases with complete tumorinduced occlusion of the sinus cavity, and Simpson IV was achieved in 2 cases with incomplete occlusion of the sinus cavity. Simpson grade I resection was achieved in 5 cases with tumor invasion of cerebral flax only. Tumors were located in the middle cortex area and invaded sagittal sinus in 7 cases. Of them, tumor invaded the sinus wall in 5 and Simpson grade I/II resection was achieved in 3 and 2 cases respectively. For the 2 cases with tumor invasion of sagittal sinus cavity, Simpson grade IV resection was achieved. All the patients had been followed up for 3 months to 5 years postoperatively. 28 cases with Simpson I resection were completely cured. Among 8 cases with Simpson II resection, only one patient had tumor recurrence and was cured with gamma knife. One year after operation, the 4 cases with Simpson IV resection showed increase of residual tumor and were treated with gamma knife. All the 4 cases were lost to follow up. 10 patients experienced hemiplegia postoperatively. After one year of followup, 6 cases recovered completely and 4 recovered partially. No death occurred.ConclusionThe combination of venous sinus imaging and skilled microsurgical techniques can effectively protect the functional cortex structures and regurgitant veins, which can reduce intraoperative bleeding, improve the total resection rate, reduce disability and tumor recurrence rate and avoid death.

Key words:Parasagittal and parafalx meningioma|Middle cortex area|Brain MRV| Microsurgery