矢状窦旁及大脑镰旁脑膜瘤的显微手术治疗76例体会

Micro-surgical Treatment for Parasagittal and Parafalcine Meningiomas

背景与目的：目前大型和复杂的矢状窦旁及大脑镰旁脑膜瘤手术治疗仍有一定难度，本文通过总结76例手术体会，探讨矢状窦旁及大脑镰旁脑膜瘤的手术治疗方法和技巧。方法：回顾性总结分析我科自2003年5月至2008年12月收治的76例矢状窦旁及大脑镰旁脑膜瘤的临床资料、诊断、手术方法及其疗效。结果：本组全部采用显微手术治疗，手术全切71例（93．4％），其中SimpsonⅠ级切除21例（27．6％），SimpsonⅡ级切除45例（59．2％），SimpsonⅢ级切除5例（6．6％），无手术死亡，术后随访6～72个月。结论：矢状窦旁及大脑镰旁脑膜瘤应力争达到SimpsonⅠ级切除；良好的手术暴露，熟练的显微手术技巧，矢状窦和中央沟静脉的妥善处理和保护，避免脑皮质损伤．是提高矢状窦旁及大脑镰旁脑膜瘤手术全切率和手术疗效的重要因素。

BACKGROUND ＆ OBJECTIVE： The management of large parasagittal and parafalcine meningiomas is still challenging. In this article, we analyzed clinical data of 76 cases with parasagittal or parafalcinc meningiomas. We also discussed operative techniques. METHODS ： The clinical data of 76 cases with parasagittal or parafalcine meningiomas, including the clinical records, the diagnosis of the disease, skill of surgical manipulation, were retrospectively analyzed,. RESULT： All the cases were treated by microsurgery. Simpson Ⅰ, Ⅱ and Ⅲ grade resection were achieved in 21 （27.6%）, 45 （59.2%） and 5 （6.6%） of the 76 cases in this series respectively. No operation-related mortality was observed. The patients were followed up for 6 to 72 months. CONCLUSIONS： Simpson I grade resection should be the goal for the surgical manangement of parasagittal and parafalcine meningiomas. Adequate exposure, effieient bleeding control, protection of sagittal sinus and drainage veins are important factors to improve operative outcome in patients with parasagittal and parafalcine meningiomas.