中颅窝脑膜瘤术中蝶顶窦引流静脉的保护
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首都医科大学三博脑科医院

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Protection of sphenoparietal sinus drainage vein during the operation of middle cranial fossa meningioma
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    目的 探讨和总结中颅窝脑膜瘤术中保护蝶顶窦引流静脉的方法及疗效。 方法 回顾性分析2008年6月至2019年6月本科室手术的27例中颅窝脑膜瘤患者的临床资料,其中男性10例,女性17例,年龄30~67岁,平均年龄55.5岁,发病时间4个月至3年。27例患者侧裂静脉呈蝶顶窦优势引流者15例,非优势引流者12例。所有患者均经额颞筋膜间入路行脑膜瘤切除术。 结果 27例中颅窝脑膜瘤患者中SimpsonII级切除24例,III级切除3例。术中3例蝶顶窦非优势引流者,因肿瘤包绕粘连,给予电凝切断。术后无一例死亡。术后一例因脑水肿加重行二次手术去骨瓣减压。随访2~13年,平均随访5.5年,无一例肿瘤复发。 结论 中颅窝脑膜瘤常累及甚至包绕蝶顶窦引流静脉,术前要详细评估静脉引流情况,术中要重视该静脉的保护,锐性分离解剖保留引流静脉,才能减轻术后脑水肿。

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    Objective To investigate and summarize the method and effect of protecting sphenoparietal sinus drainage vein in the operation of middle cranial fossa meningioma. Methods The clinical data of 27 patients with middle cranial fossa meningiomas who underwent surgery from June 2008 to June 2019 were analyzed retrospectively. There were 10 males and 17 females, aged from 30 to 67 years, with an average age of 55.5 years. The onset time was 4 months to 3 years. 15 cases had superior drainage of sphenoparietal sinus and 12 cases had non dominant drainage. Tumor resection was performed in all 27 patients via frontal-temporal interfascial approach. Results Simpson Grade Ⅱ resection was achieved in 24 cases and Simpson Grade Ⅲ resection in 3 with no deaths.3 non dominant drainage veins were cut off due to tumor wrapping and adhesion. One case underwent secondary operation to remove the bone flap due to edema. All the patients had been fllowed-up postoperatively for 2 to 13 years with an average of 5.5 years. No tumor recurrence occurred. Conclusion Meningiomas in the middle cranial fossa often involved the drainage vein of the sphenoparietal sinus. The venous drainage should be evaluated carefullly before operation.We should pay more attention to the protection of the vein, sharply separate and dissect the drainage vein, so as to avoid the occurrence of brain edema postoperatively.

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  • 收稿日期:2021-11-21
  • 最后修改日期:2022-02-07
  • 录用日期:2022-02-10
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