侵犯多颅腔和多条静脉窦复杂脑膜瘤的手术治疗

Surgical management of complicated meningioma involving multi-craniums and multi-sinus

目的探讨侵犯多颅腔和多条静脉窦复杂脑膜瘤的手术方法和技巧。方法回顾性分析我院1998年3月至2008年10月收治的5例侵犯多颅腔和多条静脉窦复杂脑膜瘤手术治疗的临床资料及随访结果。结果肿瘤切除达S impsonⅡ级2例、Ⅲ级1例、Ⅳ级2例;电凝12条静脉窦上残余肿瘤,切除直窦和右侧横窦壁外层各2例,切除左横窦1例,缝合右横窦1例,修补上矢状窦壁1例,动眼神经和脑干外残留薄层肿瘤组织1例;平均随访3.12年,按Sam ii判断标准预后良好4例,一般1例。结论精湛的显微外科技术和熟悉的显微解剖,最大限度地切除肿瘤,保护静脉窦和神经组织是脑膜瘤手术成功的关健。

Objective To explore the techniques and skill of surgical treatment of complicated meningiomas involving multi-cranium and muhi-sinus. Methods We retrospectively analyzed the clinical and follow-up data of 5 patients with meningiomas involving muhi-cranium and muhi-sinus, who were admitted between March, 1998 and October, 2008. Results The meningiomas were resected in 2 cases with Simpson grade Ⅱ , 1 case with grade Ⅲ and 2 cases with grade IV. Electric coagulation was performed on 12 venous sinuses with residual tumor. The outer layer of sinus rectus and right transverse sinus were incised in 2 cases, left transverse sinus in 1 case. Suturing right transverse sinus was performed in 1 case and restoring superior sagittal sinus in 1 case, residual tumor tissue in oculomotor nerve and outer layer of train stem was left in 1 case. A total of 3.12 years followup revealed that 4 cases were in good recovery and one was in general condition by Samii standard. Conclusion The success of surgical treatment and good prognosis of meningiomas depend on consummate microsurgical technique, skilled microdissection knowledge, the utmost resection of meningiomas and careful protection of sinus and never tissues.