巨大脑膜瘤术中术后脑肿胀的预防措施

Prevention strategies of intraoperative and postoperative cerebral swelling of giant meningiomas

目的探讨颅内巨大脑膜瘤术中术后脑肿胀脑膨出形成原因、预防措施及其并发症的防治。方法回顾性分析巨大脑膜瘤87例临床资料,通过精确定位、麻醉方法的改变、增加手术操作空间、减少脑组织牵拉、尽可能保留回流静脉以及肿瘤残腔的处理等综合措施,减少术中术后脑肿胀脑膨出发生率。结果87例患者中仅1例因脑肿胀、脑膨出影响手术进程。且根据脑膜瘤切除Simpson分级,肿瘤全切除(simpsonⅠ、Ⅱ)72例,次全切除(simpsonⅢ、Ⅳ)15例,无死亡病例。结论综合的、合理的预防措施能有效缓解术中术后脑肿胀脑膨出,提高巨大肿瘤的切除率并减少并发症发生。

Objective To investigate the reasons and prevention strategies of intraoperative and postoperative cerebral swelling , encephalocele and its complications in giant meningiomas resection . Methods The clinical data of 87 patients with giant meningiomas were analyzed retrospectively .It showed that the rate of intraoperative and postoperative cerebral swelling could be reduced by a series of comprehensive measures , such as accurate positioning , alternation of anesthesia method , expanding space of operation , preservation of bridging veins , reduction of brain retraction and management of residual cavity .Results Only one of the 87 ,the surgical process was affected by the severe cerebral swelling and encephalocele .According to Simpson grade , of 87 cases of giant meningiomas,72 were totally removed （ Simpson GradeⅠ or Ⅱ resection ）, and 15 subtotally （ Simpson Grade Ⅲ or Ⅳ） removed.No patients died from the operation .Conclusion Comprehensive and appropriate prevention strategies can improve the rate of total removal resection and reduce the postoperative complications of giant meningiomas .