大脑镰及矢状窦旁脑膜瘤显微手术治疗的研究

Study on surgical treatment for cerebral falx and parasagittal meningiomas

目的：探讨大脑镰及矢状窦旁脑膜瘤显微手术的方法及效果。方法回顾性分析47例大脑镰及矢状窦旁脑膜瘤患者的临床资料，术前影像学检查显示肿瘤位于矢状窦前1／3者27例，中1／3者11例，后1／3者9例，肿瘤最大径4～8 cm，47例患者均行显微手术治疗。结果按照切除程度划分， SimpsonⅠ级切除25例，Ⅱ级切除17例，Ⅲ级切除5例。随访时间6～49个月，SimpsonⅠ级切除的25例患者均无复发；22例SimpsonⅡ～Ⅲ级切除患者中，共有3例患者复发，均再次手术治疗。无手术死亡病例。结论术中对回流静脉、侧支静脉及静脉窦的保护，尽可能全切除或次全切除肿瘤，可以有效提高大脑镰及矢状窦旁脑膜瘤显微手术治疗的效果。

Objective To explore the method and effects of microsurgery for falx and parasagittal meningiomas .Methods The clinical data of 47 patients with falx and parasagittal meningiomas underwent microsurgery were analyzed retrospectively .Preoperative imaging showed 27 meningiomas were located in the first third of the sagittal sinus ,11 were located in the middle third and 9 were in the last third .The maximum diameters of the tumors were 4-8 cm.Results According to Simpson Grading ,25 cases were Grade I ,17 Grade II and 5 Grade III .The follow-up period ranged from 6-49 months ,there was no meningioma recurred in 25 cases of Grade I .There was no postoperationtive death ,3 of 22 patients of Grade II or III recovered and reoperated .Conclusions There are important factors to enhancing the curative effect of microsurgery on the cerebral falx and parasagittal meningiomas by protecting important drainage veins , collateral veins and sinuses , and managing complete resection .