上矢状窦中后1/3窦旁脑膜瘤的显微外科治疗

Microsurgical treatment of the middle and posterior 1/3 parasagittal sinus meningiomas

目的探讨显微外科手术治疗上矢状窦中后1/3窦旁脑膜瘤的方法和效果。方法回顾性分析显微外科手术治疗38例上矢状窦中后1/3窦旁脑膜瘤的影像资料、手术方法和手术效果。结果 SimpsonⅠ级切除5例,Ⅱ级切除24例,Ⅲ级切除5例,Ⅳ级切除4例,无死亡病例,4例肿瘤SimpsonⅣ级切除病人术后行放疗。全部病人术后均获随访,时间6~50个月,18例恢复工作。1例SimpsonⅣ切除病人术后3a肿瘤复发再次手术。结论术前充分的影像学评估,妥善处理受累矢状窦,保护好重要皮层引流静脉和功能区脑组织,是提高上矢状窦旁脑膜瘤显微外科手术治疗效果,减少并发症的关键。

Objective To explore surgical methods and treatment effect of microsurgery for parasagittal meningiomas in middle and posterior 1/3 of superior sagittal sinus.Methods The imaging data,surgical techniques and treatment effect of 38 patients with parasagittal meningiomas in the middle and posterior 1/3 sagittal sinus that underwent microsurgery were analyzed retrospectively.Results SimpsonⅠ,Ⅱ,ⅢandⅣgrade resection of meningiomas were achieved in 5,24,5 and 4 patients respectively.There was no death.4 patients with SimpsonⅣresection underwent the radiotherapy after operation.All the patients were followed up from 6-50 months.There were 18 patients returned to work.1 case of SimpsonⅣresection was recurrent in 3 years after surgery and received surgery again.Conclusion Sufficient preoperative imaging evaluation,proper treatment of sagittal sinus,and protection of cortical drainage veins and brain tissues of functional area are keys to improve curative effect and reduce complications of microsurgery of meningiomas in parasagittal sinus.