上矢状窦中后部脑膜瘤导致静脉窦闭塞后静脉代偿特点及意义

Collateral venous pathways and their clinical significance in parasagittal meningiomas obstructing middle and posterior part of superior sagittal sinus

目的 探讨中、后部矢状窦旁脑膜瘤导致静脉窦闭塞后静脉代偿特点以及全切除肿瘤的手术要点。方法 分析 15例中、后部上矢状窦完全闭塞的窦旁脑膜瘤的脑血管造影表现 ,探讨其静脉回流代偿的形式对手术疗效的影响。结果 静脉回流代偿的形式有三种 :( 1)皮层浅静脉端 端吻合 ,主要流向侧裂、Labbe静脉 ;( 2 )脑膜静脉流向蝶顶窦、海绵窦 ;( 3)板障静脉流向头皮。本组肿瘤全切除 12例 ,无手术死亡 ,术后发生三肢瘫 1例 ,双下肢瘫 1例 ,高颅压、失明 1例。结论 术前仔细研究血管造影上静脉回流代偿的形式 ,有助于术中加强对其保护 ,减少全切除肿瘤手术后的严重并发症的发生。

Objective To investigate the compensatory patterns of venous reflux in parasagittal meningioma obstructing the middle and posterior parts of superior sagittal sinus, and to discuss their clinical significance and the key points in total removal of the tumors. Methods Preoperative angiographic images on venous phase and the surgical results were analyzed in 15 patients of parasagittal meningiomas with obstruction of the middle and posterior parts of superior sagittal sinus. Results Three venous compensatory patterns were included:(1)end-to-end anastomoses of superficial veins of the cerebrum(mainly Trolard and Labbe)draining to cavernous sinus and transverse sinus, (2)meningeal veins draining to sphenoparietal and cavernous sinus, and (3)the diploic vein draining to scalp vein. Gross total resection of the tumor was reached in 12 patients. Postoperatively, one patient developed triplegia, 1 patient left paresis in both lower extremities,1 had increased ICP and blindness, but no patient died. Conclusions Understanding the venous compensatory patterns in parasagittal meningioma with obstruction of superior sagittal sinus before operation is helpful in preserving them during the operation and avoiding serious complications after total removal of the tumor.