矢状窦旁脑膜术后脑出血及脑水肿原因分析及治疗

Analysis and treatment of cerebral hemorrhage and cerebral edema in patients with parasagittal meningeal after surgery

目的探讨矢状窦旁脑膜瘤术后脑出血及脑水肿形成原因及治疗。方法回顾性分析12例矢状窦旁脑膜瘤术后并发脑出血及脑水肿的临床资料。结果9例术后复查CT示脑水肿,加强脱水利尿治疗后好转;2例术后复查CT示瘤腔内少量出血伴重度脑水肿,激素治疗并加强脱水治疗后好转;1例术后复查CT示脑内血肿伴中线结构移位,开颅血肿清除术治疗,术后有轻偏瘫及癫痫,经功能锻炼后肌力在Ⅲ~Ⅳ级。结论术中静脉损伤可能是矢状窦旁脑膜瘤术后脑出血及脑水肿的主要原因之一,术前充分影像学评估、术中按临床分型充分保护静脉、术后规范化管理,可降低术后脑出血和脑水肿发生率。

Objective To explore the causes and treatment of cerebral hemorrhage and cerebral edema in the patients with parasagittal meningiomas after surgery.Methods The clinical data of 12 patients with parasagittal meningiomas complicated with cerebral hemorrhage and cerebral edema after operation were retrospectively analyzed.Results The postoperative CT scan showed cerebral edema in 9 patients who were improved after treatment with intensive dehydration and diuretic treatment,small amount of hemorrhage in the tumor cavity associated with severe cerebral edema in 2 patients who were improved after steroid therapy and intensive dehydration treatment,intracerebral hematoma with midline structural displacement in 1 who had hemiplegia and epilepsy after hematoma removal by craniotomy.Conclusions Intraoperative venous injury may be one of the main causes of postoperative cerebral hemorrhage and cerebral edema in patients with parasagittal meningioma.Adequate imaging evaluation before operation,adequate protection of veins according to clinical classification during the operation,and standardized postoperative management can reduce the incidence of postoperative cerebral hemorrhage and cerebral edema.