窦旁脑膜瘤35例术前影像评估和显微手术治疗

Preoperative imaging evaluation and microsurgery management of 35 cases of sinus meningioma

目的 探讨窦旁脑膜瘤的术前影像评估作用和显微手术治疗的手术策略,以提高手术治疗效果。方法 回顾性分析35例各类窦旁脑膜瘤的MRI平扫、MRI增强检查、三维螺旋CT血管造影或三维数字减影血管造影（3D-CTA/CTV）检查结果,显微手术中不同情况下静脉窦的修复重建方法及疗效。结果 按Simpson切除分组标准,Ⅰ级切除30例（85%）,Ⅱ级切除4例（11%）,Ⅲ级切除1例（4%）。术中均对静脉窦进行重建。术后随访3~48个月,恢复良好,肿瘤未见复发。结论 3D-CTA/CTV可以显示肿瘤的血供、肿瘤周围骑跨血管、静脉窦与肿瘤的关系,可为术前手术方案的制定提供帮助。显微手术需根据肿瘤对静脉窦的侵袭情况采取多种静脉窦修复与重建的方法,其间需注意保护周围的动静脉。超声刀及射频刀的合理应用可以减少静脉窦及脑组织的损伤,术中电生理监测可避免功能区损伤,减少并发症的发生。

Objective To explore the evaluation value of preoperative imaging and the treatment strategy of microsurgery for sinus meningioma, in order to improve the efficacy of surgery. Methods The results of MRI scan, enhanced MRI scan and 3D-CT angiography and the reconstruction method, and efficacy of the venous sinuses under different circumstances during microsurgery of 35 patients with various types of meningioma were analyzed retrospectively. Results According to Simpson grading system, there were 30 cases （85%） of grade I resection, 4 cases （11%） of grade Ⅱ resection, and 1 case of grade Ⅲ （4 %） resection. The reconstruction of venous sinuses was performed of all cases during operation. The follow-up ranged from 3 to 48 months, and all the patients recovered well and had no recurrence. Conclusion 3D-CTA/CTV may display the blood sup- ply artery oi the tumor, the straddle vessel around the tumor and the relationship between venous sinuses and tumor. It can supply vital information for preoperative surgical plan. Microsurgery could adopt multiple methods to repair and reconstruct si- nus. At the same time, it must pay enough attention to protect the surrounding arteriovenous. The application of ultrasonic scalpel and radiofrequency coblation can reduce damage of the brain tissue and venous sinus. As to the tumor in functional areas, the application of intraoperative electrophysiological monitoring can avoid the damage of domain and reduce the incidence of complications.