上矢状窦中1／3窦旁脑膜瘤的手术处理策略

Surgical treatment strategies for the middle third of parasagittal meningioma

目的探讨有效切除上矢状窦中1／3窦旁脑膜瘤的方法以便提高其临床疗效，并降低术后并发症。方法通过采用患侧卧位并尽可能保留上矢状窦和引流静脉的前提下行肿瘤相对保守的切除策略，当肿瘤残留明显或随访期间肿瘤进展则给予辅助放射治疗，最后对手术疗效及其术后并发症等临床资料进行统计学分析。结果124例患者中96例（77．4％）获得全切除，28例（22．6％）大部切除。术后随访6—60个月，复发13例（10．5％），其中男4例（9．3％），女9例（12．2％），全切除患者复发9例（9．4％），次全切除患者复发4例（14．3％），复发率在不同性别之间差异无统计学意义（P〉0．05），全切除患者与次全切除患者之间复发率差异无统计学意义（P〉0．05）。术后120患者恢复良好并参加工作，2例（1．6％）致残，但可生活自理，2例（1．6％）死亡，1例死于肺栓塞，1例死于心肌梗死。结论采用患侧卧位和显微外科技术有利于切除肿瘤的同时保护引流静脉和大脑皮层，尽可能保留通畅的上矢状窦和引流静脉可降低术后致死致残率，必要时术后加用放射治疗也可取得良好的远期疗效。

Objective To investigate the methods of effective removal of the middle third parasagittal meningioma in order to improve its clinical efficacy and decrease the postoperative complications. Methods The tumors were resected with a relatively conservative strategy by using lateral supine and preserved the superior sagittal sinus and draining veins as much as possible. When tumor residues were obvious and progressive during the follow-up period, they were given adjuvant radiation therapy. Finally, the clinical data including surgical effect and postoperative complications were analyzed statistically. Results Of the 124 patients, 96 （77.4%） achieved total resection; 28 （22. 6% ） achieved subtotal resection. They were followed up for 6 to 60 months after procedure, 13 （ 10. 5% ） had recurrence, including 9 females （ 12. 2% ） and 4 males （9. 3% ）. Nine patients （9. 4% ） of total resection had recurrence, 4 （ 14. 3% ） of total resection had recurrence. There was no significant difference in the recurrence rate between the different genders （ P 〉 0. 05 ）. There was no significant difference in the recurrence rate between the patients of total resection and those of subtotal resection （ P 〉 0. 05 ）. After procedure, 120 patients recovered well and returned to work. Two （1.6%） had disability, but they could take care of themselves. Two patients （ 1.6% ） died, one died of pulmonary embolism and the other died of myocardial infarction. Conclusions Using lateral supine and microsurgieal techniques are conducive to the resection of tumors while protecting the draining veins and cerebral cortices. Preserving the patency of the superior sagittal sinus and draining vein as much as possible may reduce the postoperative mortality and disability. If necessary, using radiotherapy after procedure can also achieve good long-term efficacy.