老年人上矢状窦旁脑膜瘤术后脑水肿及脑血管痉挛原因分析及治疗体会

Cause and treatment of postoperation cerebral edema and cerebral angiospasm of old patients with latero-superior sagittal sinus meningioma

目的探讨老年上矢状窦旁脑膜瘤患者术后脑水肿及脑血管痉挛原因及其预防及治疗方案。方法选择本院2003年1月～2006年9月间行经病理证实的老年上矢状窦旁脑膜瘤患者48例,全部经术前CT、MRI检查及手术治疗。术后及时给予抗血管痉挛药物及改善微循环药物,常规腰穿检查颅内压及复查头部CT。结果术后颅内压增高40例(83.3%),术后CT显示脑组织水肿较术前加重32例(66.7%)。术后出现脑水肿及脑血管痉挛致神经功能障碍18例(37.5%),其中经应用抗血管痉挛药物及改善微循环药物的治疗观察1～2w内完全恢复12例(66.7%),4例(22.2%)出院后复查时完全恢复,2例(11.1%)出现脑梗死。无死亡病例。结论老年上矢状窦旁脑膜瘤患者术后脑水肿及脑血管痉挛易造成神经功能缺失,术中皮质引流静脉的保留及保护能有效的减轻术后局部脑水肿的发生;术后早期应用扩容、抗血管痉挛药物及改善微循环药物可有效防治术后脑水肿及血管痉挛的发生及所引起的神经功能缺失。

Objective To investigate the cause,incidence and remission rate of postoperation cerebral edema and cerebral angiospasm of old patients with latero-superior sagittal sinus meningioma,and to discuss the preservation and the treatment scheme.Methods 48 cases of the old age patients with latero-superior sagittal sinus meningioma were chosed from January 2003 to September 2006.All cases were confirmed to be the latero-superior sagittal sinus meningioma by preoperative MRI,operation and postoperative pathology.Lumbar puncture was adopted as the postoperation routine to messure the ICP(intracranial pressure),CT after the operation was rechecked and compared with the preoperative CT.Results There were 40(83.3%) cases' ICP increased after the operation,32(66.7%) cases' CT results showed the cerebral edema aggravated after the operation,18(37.5%) cases appeared the absence of the nerves function casued by cerebral edema and cerebral angiospasm.After the anti-vasospasm and the microcirculation amelioration treatment for 1～2 weeks,12 cases totally recovered.4 cases recuperated when they were rechecked after discharged,and 2 of them got the cerbral infarction.Conclusion In the old patients with latero-superior sagittal sinus meningioma,the postoperation cerebral edema and cerebral angiospasm can cause the absence of the nerves function easily.Prudent use the hemostatic,at the earlier period use the fluid expansion and anti-vasospasm and the microcirculation amelioration treatment,all these methods can effectively prevente and cure the absence of the nerves function casued by cerebral edema and cerebral angiospasm.