侵入上矢状窦脑膜瘤36例临床研究

Meningiomas invading the superior sagittal sinus in 36 cases

目的 提高对侵入上矢状窦脑膜瘤的手术治疗效果.方法 回顾性分析我院2004年1月至2009年6月间手术切除的36例侵入矢状窦脑膜瘤盘床表现、诊断方式和显微手术疗效.结果 按Simpson切除分级标准:Ⅰ级切除26例,占72.2%;Ⅱ级切除7例,占19.4%.脑膜瘤致上矢状窦完全闭塞,脑膜瘤并窦完全切除者11例.无手术死亡,术前症状及体征均有不同程度改善或消失.随访0.5～4.6年(平均2.3年),仅有1例术后3.8年复发,再次手术前窦已闭塞,将窦连同肿瘤一并切除.结论 脑膜瘤不全侵犯上矢状窦时,可将窦切开,在全切肿瘤的基础上,对静脉窦进行重建或修补保持窦的通畅.脑膜瘤致矢状窦完全阻塞的,可将受侵犯的窦段全切.采用显微神经外科技术保护重要结构,吻合重建血管是提高全切率,减少术后并发症,改善患者术后生存质量的重要因素.

Objective To improve the curative effect of microsurgery for meningiomas invading the superior sagittal sinus. Methods A retrospective analysis was performed in 36 patients with meningiomas invading the superior sagittal sinus who were treated in our department from January 2004 to June 2009, includingthe clinical presentations, the diagnostic methods and the effect of microsurgery treatment. Results According to Simpson classification of glioma resection, among the 36 patients, Grade Ⅰ resection was performed in 26 cases(72.2 %),Grade Ⅱ in 7 cases(19.4%),11 patients with meningiomas totally occluding the SSS had complete resection of the encased portion of the sinus. No patient died from the surgery, all the patients recovered well after the treatment. Following-up ranged from 0.5 to 4.6 years(mean 2.3year) in 36 patients showed that only one patient suffered a recurrence 3.8 years after the surgery. With total sinus occlusion when received reoperation. Conclusions If the sinus is partially invaded, it can be opened to obtain as complete a resection as possible and to reconstruct the sinus and preserve the patency of the sinus. If the sinus is obstructed, the portion of the sinus involved can be resected completely. Application of microsurgical techniques and restoration are important factors in increasing the success rate of surgical resection, reducing post-operative complications and improving the quality of life.