大脑中浅静脉区域脑膜瘤瘤周引流静脉损伤与术后认知改变的相关性分析

Correalation between injury of draining veins around meningiomas in superficial middle cerebral vein areas and postoperative cognitive changes

探讨大脑中浅静脉区域脑膜瘤瘤周引流静脉损伤与术后认知功能改变的关系,以指导显微神经外科手术治疗.方法回顾性分析广东省农垦中心医院2013年7月至2017年7月治疗的大脑中浅静脉区域脑膜瘤患者(肿瘤组)54例的临床资料.采用中文版蒙特利尔认知评估量表(MoCA)、影像学指标(CT/MRI)对54例脑膜瘤患者、52例健康志愿者(对照组)的认知功能、瘤周水肿体积(MPE)进行术前、术后评估,并进行统计学分析.结果大脑中浅静脉区域脑膜瘤患者术前视空间/执行能力[(3.23 ± 1.27)分]、命名能力[(2.52 ±1.27)分]、记忆能力[(2.20 ±1.14)分]、注意能力[(4.71 ±0.97)分]、语言能力[(2.19 ±0.74)分]、抽象能力[(1.43 ±0.63)分]、定向能力[(5.83 ±0.42)分]评分及总分[(22.06 ± 0.33)分]均低于对照组的(4.83 ±0.38)分、(3.0 ±0.02)分、(3.5 ±1.04)分、(5.98 ±0.14)分、(2.54 ± 0.50)分、(1.88 ±0.38)分、(5.98 ±0.33)分及(27.83 ±0.16)分( t =4.504、6.116、9.338、2.782、4.509、2.390、8.670,均P<0.05).瘤周引流静脉无损伤组与损伤组术前、术后5 d的MoCA总分和脑水肿体积的差异无统计学意义(P>0.05),术后30 d两组MoCA总分[(26.35 ±0.36)比(22.00 ±0.67)分]和脑水肿体积[(23.95 ±4.34)cm^3 比(44.64 ±9.68)cm^3 ]差异均有统计学意义(t=5.944、2.098,均P<0.05). 43例瘤周引流静脉无损伤患者术前、术后5 d及术后30 d的MoCA评分和脑水肿体积差异均有统计学意义(t=5.055、7.289、2.232、5.014,均P<0.05),而11例瘤周引流静脉损伤患者术前、术后5 d及术后30 d的MoCA评分和脑水肿体积差异均无统计学意义(均P>0.05).结论大脑中浅静脉区域脑膜瘤患者术中瘤周引流静脉损伤可引起术后认知功能改变,影响患者术后生活质量,手术中应尽量避免损伤瘤周引流静脉.

Objective To explore the correalation between change of postoperative cognitive function and injury of the draining veins around meningiomas in superficial middle cerebral vein areas ,to discuss the importance and protection method of draining veins around meningiomas in order to guide the microneurosurgery .Methods From July 2013 to July 2017,the clinical data of 54 patients with superficial middle cerebral vein areas meningiomas (tumor group) in the Central Hospital of Guangdong Nongken were retrospectively analyzed .And 52 healthy volunteers were selected as the control group.The preoperative and postoperative cognitive function and meningiomas peritumoral edema(MPE) were assessed by the Montreal Cognitive Assessment ( MoCA) and CT/MRI.Results The scores of visuospatial and executive [(3.23 ±1.27)points],order[(2.52 ±1.27) points],memory[(2.20 ±1.14) points], attention[(4.71 ±0.97)points],language[(2.19 ±0.74)points],abstract [(1.43 ±0.63)points],location[(5.83 ± 0.42) points],total[(22.06 ±0.33) points] in the tumor group were significantly lower than those in the control group[(4.83 ±0.38)points,(3.0 ±0.02)points,(3.5 ±1.04)points,(5.98 ±0.14)points,(2.54 ±0.50) points,(1.88 ±0.38) points,(5.98 ±0.33) points,(27.83 ±0.16) points]( t =4.504,6.116,9.338,2.782,4.509, 2.390,8.670,all P<0.05).According to the injury of the draining veins around meningioma ,54 patients were divided into the two groups,43 cases in the no -injuried group,11 cases in the injuried group.There were no statistically significant differences between the no -injuried group and injuried group in all measurements before operation (all P>0.05).Both no-injuried group and injuried group had decline in MoCA and increase in MPE at 5 days after surgery. Both no-injuried group and injuried group had rise in MoCA [(26.35 ±0.36)points vs.(22.00 ±0.67)points] and decrease in MPE[(23.95 ±4.34)cm^3 vs (44.64 ±9.68) cm^3 ] at 30 days after surgery ( t=5.944,2.098,all P<0.05).The MoCA[(22.59 ±0.31)points vs (26.35 ±0.36)points] was obviously increased and the MPE [(87.84 ± 12.78)cm^3 vs.(23.95 ±4.34)cm^3] was obviously increased in 30 days after operation in no-injuried group(t=7.289, 5.014,all P<0.05),but the injuried group had just the opposite.Conclusion Injury of the draining veins around meningiomas in superficial middle cerebral vein areas can lead to cognitive dysfunction and compromise the quality of postoperative life in patients,every effort should be undertaken to preserve the draining veins around meningioma .