巨大矢状窦镰旁脑膜瘤显微外科治疗

Microsurgery Treatment of Meningiomas in the Large Parasagittal Sinus and Cerebral Falx

目的探讨显微外科技术在矢状窦镰旁双侧巨大脑膜瘤手术中的应用。方法采用跨中线骨瓣、双侧条状镰旁硬脑膜瓣、牵引脑膜瓣向上矢状窦对侧、沿脑沟切开脑组织并向额叶枕叶方向牵开和经纵裂切除肿瘤等显微手术技术切除32例上矢状窦镰旁巨大脑膜瘤。结果肿瘤Simpson Ⅰ级21例,Simpson Ⅱ级9例,Simpson Ⅲ级2例;1例术后昏迷、家属放弃治疗;术后随访6～36个月,肿瘤复发2例。结论采用显微外科技术,充分暴露肿瘤,有效控制出血,保护回流静脉,妥善处理矢状窦,减少并发症,保护神经功能,尽可能全切或次全切除肿瘤,减少肿瘤复发,提高术后生存质量。

Objective To investigate the application of microsurgical techniques in the operation of bilateral large meningiomas in the superior parasagittal sinus and cerebral falx. Methods 32 patients with large meningiomas in the superior parasagittal sinus and cerebral falx were treated with a series of microsurgical techniques. Results Simpson Ⅰ grade removal was detected in 21 patients, Simpson Ⅱ grade in 9 patients, Simpson Ⅲgrade 2 patients. 1 patient fell into comatose state after operation, the treatment of whom was abandoned by family member. The follow-up period of patients ranged from 6 to 36 months, and tumor recurrence was observed in 2 cases. Conclusions The application of microsurgery could fully disclose tumor, effectively control hemorrhage and protect refluxing vein, appropriately treat parasagittal sinus, reduce complications and protect neural function of the brain, sub-resect the tumor or resect it as far as possible, reduce its recrudescence, and enhance the postoperative life quality of patients.