中央回区矢状窦旁脑膜瘤的术前影像评估和显微外科治疗

Preoperative diagnostic value of imaging and microsurgical treatment for parasagittal meningiomas in central gyrus region

目的 探讨中央回区矢状窦旁脑膜瘤术前影像评估价值和手术策略要点,提高肿瘤切除率和手术效果.方法 对MRI扫描诊断为中央回区矢状窦旁脑膜瘤的25例患者行MRV检查,了解肿瘤的血供、矢状窦通畅程度及瘤周静脉回流代偿情况.采用额顶部过中线马蹄形切口,充分显露肿瘤前后极矢状窦,术中阻断窦旁供血,囊内分块切除肿瘤,保护中央沟静脉和代偿回流静脉,妥善处理受累的矢状窦.结果 25例中央回区矢状窦旁脑膜瘤患者中,MRV结合MRI对矢状窦受侵及瘤周回流静脉的显示与术中所见高度一致.18例SimpsonⅡ级全切除,7例SimpsonⅣ级次全切除.术后患者恢复良好,新增对侧肢体感觉障碍5例、肌力下降3例、精神障碍2例,随访恢复正常.结论 充分的术前影像学评估,MRV结合常规MRI图像能够敏感的显示矢状窦的通畅情况以及瘤周静脉情况,熟练的显微外科技术可以有效保护重要引流静脉、侧副静脉及静脉窦,是提高中央回区矢状窦旁脑膜瘤手术疗效的重要因素.

Objective To discuss the value of the preoperative image assessment and surgical strategy of parasagittal meningiomas in central gyrus region,in order to raise the resection rate of tumors and surgical effects.Methods 25 patients with parasagittal menigioma in central gyrus region were examined by routine MRI and MRV to evaluate the blood supplies of the tumor,degree of involvement of the sagittal sinuse and collateral veins.During the operation,a frontoparietal cross-midline horseshoe incision was performed.The parasagittal blood supplies were blocked at first and then the tumors were removed piece by piece.The Rolandic veins and compensative veins were protected.The sagittal sinuses were appropriately dealt with.Results The visualization of 25 parasagittal meningiomas in central gyrus region invading the sagittal sinuses and the draining veins was achieved through MRV and MRI scanning.The results were highly coincidence with the findings in the operation.18 tumors were removed with Simpson Ⅱ grade,and 7 Simpson Ⅳ.Postoperatively,5 patients developed hemiparesthesia,3 hemiparesis,and 2 mental disorders.All the complications were recovered satisfactorily during follow-up period.Conclusions Sufficient preoperative imaging evaluation,MRV combined with conventional MRI,could sensitively show the degree of involvement of the sagittal sinus and collateral veins.Skillful microsurgical technique was helpful to protect important drainage veins,collateral veins and sinuses,and increase surgical outcome in patients with parasagittal menigioma in central gyrus region.