桥静脉位置及术中保留对窦镰旁脑膜瘤患者切除术后早期预后的影响  

Effects of anatomic position and intraoperative preservation of bridging veins on prognoses early after surgery in patients with parasagittal and parafalx meningiomas

作　　者：王飞[1] 王勇[1] 周玮林 耿鑫[1] 孙涛[1] 余化霖[1] 

机构地区：[1]昆明医科大学第一附属医院神经外二科,昆明650032

出　　处：《中国临床神经外科杂志》2015年第6期335-337,共3页Chinese Journal of Clinical Neurosurgery

基　　金：国家自然科学基金(81260182);云南省科技厅联合专项研究基金(2012FB036)

摘　　要：目的探讨桥静脉解剖位置及其术中保留对窦镰旁脑膜瘤切除术后早期预后的影响。方法回顾性分析120例窦镰旁脑膜瘤患者的临床资料,桥静脉位于矢状窦镰旁脑膜瘤表面为Ⅰ型,桥静脉位于肿瘤深部为Ⅱ型。预后不良包括术后神经功能障碍加重、新增神经功能障碍及死亡。结果术中发现Ⅰ型95例,Ⅱ型14例,11例未发现桥静脉仅在肿瘤深部发现皮层静脉。术后早期预后不良13例(10.8%),其中死亡4例(3.3%),新增或原神经功能障碍加重9例(7.5%)。Ⅰ型病例中,52例术中离断桥静脉,早期预后11例(21.1%);43例术中未离断桥静脉,早期预后不良1例(2.3%);两者术后早期预后不良发生率差异显著(P<0.01)。所有病例中,52例术中离断桥静脉,早期预后不良11例(21.1%);68例术中未离断桥静脉,早期不良预后2例(3.5%);两者术后早期不良预后不良发生率差异显著(P<0.01)。结论桥静脉位于窦镰旁脑膜瘤时,术中容易损伤;桥静脉一旦损伤,术后早期预后不良发生率显著增高;我们建议提高桥静脉的保留率以减少手术的直接并发症。Objective To explore the value the position and intraoperative preservation of the bridging veins to the prognoses early after surgery in the patients with parasagittal and parafalx meningiomas. Methods Of 120 patients with parasagittal and parafalx meningiomas, 103 underwent surgery via ipsilateral transdural approach and 17 via bilateral transdural approaches. One or more than one bridging veins were on the parasagittal and parafalx meningiomas surfaces in 95 patients, the bridging veins were not on the timorous surfaces in 14 patients and the bridging veins were not seen in 11 patients. Results Of 95 patients in whom the bridging veins were on the timorous surfaces, 52 underwent cutting off bridging veins and 43 not. There were bad prognoses in 13 patients （10.8%）, of whom, 4 （3.3%） died and 9 （7.5%） had the aggravation of the neurological deficits or new neurological deficits produced by the surgery. The rate of bad prognosis （21.29%, 11/52） was significantly higher in 52 patients with cutting off the bridging veins than that （2.3%, 1/43） in 43 patients without cutting off the bridging veins of 95 patients in whom the bridging veins were on the timorous surfaces （P〈0.01）. Conclusion The prognosis after the surgery may be significantly improved by the intraoperative preservation of the bridging veins on the timorous surfaces in the patients with parasagittal and parafalx meningiomas.

关 键 词：窦镰旁脑膜瘤 桥静脉 预后 

分 类 号：R739.41[医药卫生—肿瘤] R651.11[医药卫生—临床医学]