中央回区矢状窦旁脑膜瘤的显微手术治疗  被引量:10

Microsurgical treatment of parasagittal meningiomas in central area

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作  者:郭文[1] 周庆九[1] 刘波[1] 买买提力[1] 卡合尔曼[1] 付强[1] 吉文玉[1] 秦虎[1] 刘海波[1] 柳琛[1] 

机构地区:[1]新疆医科大学第一附属医院神经外科,乌鲁木齐830054

出  处:《中华神经外科杂志》2014年第9期896-899,共4页Chinese Journal of Neurosurgery

摘  要:目的 探讨中央回区矢状窦旁脑膜瘤的手术方法和治疗效果.方法 应用显微手术治疗中央回区矢状窦旁脑膜瘤36例.对36例患者的影像学资料、手术入路、显微手术方法进行回顾性分析.结果 Simpson Ⅰ级切除4例,Ⅱ级切除15例,Ⅳ级切除17例,无手术死亡.术后出现脑水肿及梗死2例,行去骨瓣减压术,术后3个月行颅骨修补术,均恢复工作和生活;术后5例肢体肌力有所改善;10例术后肢体活动障碍新发或加重,其中7例1~8周逐渐恢复,3例一侧肢体不全瘫痪.17例(Ⅳ级切除)术后1个月内行放射治疗.术后随访25例,随访时间3个月~3年.3例SimpsonⅣ级切除的患者术后1~3年复发,均再次手术.结论 充分的术前评估、术中避免脑皮质的损伤、中央沟静脉及引流静脉的保护和上矢状窦的合理处理均可保证和提高手术疗效.术中不应过分追求肿瘤全切除而损伤功能区脑组织、引流静脉及上矢状窦.Objective To evaluate the surgical methods and treatment effects of the parasagittal meningiomas in central area.Methods 36 cases with parasagittal meningiomas in the central area were treated with microsurgery.The imaging data,surgical approaches,surgical techniques and strategies of the tumor were analyzed retrospectively.Results Simpson Ⅰ,lⅡ,and Ⅳgrades resection were achieved in 4,15,and 17 patients respectively.There was no death.Two patients developed cerebral edema and infarction and surgical decompression was performed.The cranioplasty was carried out after 3 months and all the 3 patients returned to normal life.The limb muscle strength of 5 cases were improved.Hemiparalysis was deteriorated in 10 patients,7 of them recovered spontaneously within 1 to 8 weeks,and the other 3 developed hemiparesis.17 cases (Simpson Ⅳ resection) underwent the radiotherapy within one month.25 patients were followed-up from 3 months to 3 years.3 patients had recurrent meningiomas in 1 to 3 years after the operation and underwent surgery again.Conclusions Sufficient preoperative evaluation,choosing appropriate surgical approaches,avoiding injury of brain cortex,central sulcus vein,venous drainage and superior sagittal sinus were the keys for ensuring and improving the curative effects of the operation.The pursuit of total resection should be avoided when the tumor with close brain tissue adhesion,close central sulcus vein and around tumor venous drainage adhesion,and the invasion to superior sagittal sinus.

关 键 词:上矢状窦 中央沟静脉 脑膜瘤 显微外科手术 

分 类 号:R739.45[医药卫生—肿瘤]

 

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