显微手术治疗矢状窦、大脑镰脑膜瘤的疗效分析

Efficacy Analysis of Microsurgery in the Treatment for Meningioma in Sagittal Sinus and Falx Cerebri

目的：探讨显微手术治疗矢状窦、大脑镰旁脑膜瘤的策略和手术操作要点。方法：回顾分析73例矢状窦、大脑镰旁脑膜瘤患者的临床资料,其中矢镰前1/3段肿瘤19例、中1/3段46例、后1/3段8例;肿瘤基底位于矢状窦27例,位于大脑镰33例,矢状窦和大脑镰同时受侵13例。应用显微手术技术切除肿瘤,并处理受侵犯的矢状窦和大脑镰。结果：肿瘤SimpsonⅠ级切除24例,Ⅱ级切除46例,Ⅲ级切除3例;无手术死亡患者;无严重脑水肿和静脉性脑梗死病例。64例随访6个月-7年,肿瘤复发6例（9.3%）。结论：通过显微手术对矢状窦、大脑镰脑膜瘤进行全切时,正确处理受累的矢状窦和大脑镰以及保护引流静脉是获得良好手术效果的关键。

Objective：To explore the strategies and key operation points of microsurgery in the treatment of meningioma in sagittal sinus and falx cerebri.Methods：The clinical data of 73 patients with meningioma in sagittal and beside cerebral falx were analyzed retrospectively.The tumors located in the anterior 1/3 segment of sagittal sinus or cerebral falx in 19 cases,in the central 1/3 segment in46 cases,and in the posterior 1/3 segment in8 cases.The base of tumors originated from the sagittal sinus in27 cases,originated from the cerebral falx in33 cases,and involved with both the sagittal sinus and the falx cerebri in13 cases.Microsurgery technique was applied to resect the tumors,and to treat with sagittal sinus or falx cerebri invaded by tumor.Results：There were 24 cases of Simpson Grade I resection,46 cases of Simpson Grade II resection,and 3 cases of Simpson Grade III resection.No case died due to operation.No case suffered from severe cerebral edema or cerebral venous infarction.64 cases were followed up for 6 months to 7 years,and tumors recurred in 6 cases（9.3%）.Conclusions：During the microsurgical operation for total resection of the meningioma in sagittal sinus and falx cerebri,the correct treatment for involved sagittal sinus and falx cerebri,as well as the protection for bridging venous,is the key to achieve satisfactory effect of operation.