摘要
目的上矢状窦中后1/3处涉及感觉、运动功能区及数条重要回流静脉,探讨此处侵袭性窦旁脑膜瘤的手术策略,以最大程度地保护患者安全。方法回顾性分析2010年4月至2018年4月徐州医科大学附属医院神经外科收治的99例上矢状窦中后1/3处侵袭性窦旁脑膜瘤患者的临床资料。分为2组:Ⅰ组,显微镜下肿瘤完全切除,包括上矢状窦内肿瘤的全切除59例;Ⅱ组,显微镜下切除上矢状窦外的肿瘤,包括窦壁肿瘤,但矢状窦未切开,窦内肿瘤未处理,术后给予γ刀治疗者40例。分析Ⅰ组患者术后并发症发生的独立危险因素,比较2组患者术后并发症的发生率、治疗后5年复发率、治疗后3个月生活质量KPS评分为优(大于90分)患者占比等,并进行统计学分析。结果Ⅰ组中,单因素分析及多因素logistic回归分析显示,患者年龄≥60岁、肿瘤位于上矢状窦中1/3、肿瘤质地韧、瘤周引流静脉>3条是患者术后发生并发症的独立危险因素(P<0.05)。治疗后3个月KPS评分为优的患者人数比例:Ⅰ组为64.4%,Ⅱ组为62.5%,二者差异无统计学意义(P>0.05);Ⅰ组术后并发症发生率为22.0%,Ⅱ组为7.5%,二者对比差异有统计学意义(P<0.05)。Ⅰ组5年复发率为10.16%,Ⅱ组为12.5%,二者差异无统计学意义(P>0.05)。结论矢状窦切开切除窦内肿瘤技术条件要求较高且具有一定风险性。对于年龄≥60岁、肿瘤位于上矢状窦中1/3且侵及窦内者、瘤周静脉数量>3条、肿瘤质地韧的患者,术中不处理上矢状窦内残余肿瘤,术后行γ刀等放射治疗也可以达到较为满意的临床治疗效果。
Objective The middle and posterior one-third segment of the superior sagittal sinus involves sensory and motor function areas and several important reflux veins.The article is to explore the surgical strategy of invasive parasagittal meningioma,so as to maximize the safety of patients.Methods A total of 99 patients who were admitted to Department of Neurosurgery,the Affiliated Hospital of Xuzhou Medical University from April 2010 to April 2018 and diagnosed with invasive parasinus meningioma at the middle and posterior one-third of the superior sagittal sinus were selected and their clinical data were retrospectively analyzed.They were divided into two groups:group I,including 59 patients who underwent total tumor resection in the superior sagittal sinus under a microscope,and group II,including 40 patients who underwent tumor resection outside the superior sagittal sinus under a microscope(the sagittal sinus was not incised and the tumor inside the sinus were not treated),before treatment with γ knife.The independent risk factors for postoperative complications in group Ⅰ were analyzed.Both groups were compared for the incidences of postoperative complications,5-year recurrence rate after treatment,and the proportion of patients with excellent(>90 points)KPS score for the quality of life three months after treatment.Results Univariate analysis and multivariate logistic regression analysis showed that patients aged≥60 years,tumors located at the middle one-third segment of the superior sagittal sinus,tough tumor texture,more than three draining veins around the tumor were the independent risk factors of postoperative complications(P<0.05).The proportion of patients with excellent KPS scores three months after treatment was 64.4% for group Ⅰ and 62.5% for group Ⅱ,without statistical differences(P>0.05).The incidence of postoperative complications was 22.0% for group Ⅰ and 7.5% for group Ⅱ,which were statistically different(P<0.05).The 5-year recurrence rate was 10.16% for group 1 and 12.5% for group 2,without statistical difference(P>0.05).Conclusions Resection of intrasinus tumors through sagittal sinus incision requires advanced skills and shows certain risks.For patients aged≥60 years,with tumors located at the middle one-third segment of the superior sagittal sinus and invading the sinus,with more than three veins around the tumor,and tough tumor texture,post-operative treatment of residual tumors in the superior sagittal sinus through γ knife or other radiotherapy,rather than during surgery,can also achieve satisfactory clinical outcomes.
作者
张奇
董成祥
陆岳
李峰达
华磊
范月超
ZHANG Qi;DONG Chengxiang;LU Yue;LI Fengda;HUA Lei;FAN Yuechao(Department of Neurosurgery,the Affiliated Hospital of Xuzhou Medical University,Xuzhou,Jiangsu 221002,China)
出处
《徐州医科大学学报》
CAS
2024年第2期131-135,共5页
Journal of Xuzhou Medical University
基金
江苏省自然科学基金面上项目(BK20181152)。
关键词
上矢状窦
脑膜瘤
显微切除
Γ刀治疗
远期疗效
superior sagittal sinus
meningioma
microsurgical resection
γknife therapy
long-term efficacy