中颅窝脑膜瘤术中蝶顶窦引流静脉的保护  

Protection of sphenoparietal sinus drainage vein during the operation of middle cranial fossa meningioma

作　　者：刘宁[1] 韩松[1] 杨亚坤[1] 张林朋 刘亚伯 闫长祥[1] LIU Ning;HAN Song;YANG Yakun;ZHANG Linpeng;LIU Yabo;YAN Changxiang(Department of Neurosurgery,Sanbo Brain Hospital,Capital Medical University,Beijing 100093,China)

机构地区：[1]首都医科大学三博脑科医院神经外科,北京100093

出　　处：《中国耳鼻咽喉颅底外科杂志》2022年第3期66-69,共4页Chinese Journal of Otorhinolaryngology-skull Base Surgery

摘　　要：目的 探讨和总结中颅窝脑膜瘤术中保护蝶顶窦引流静脉的方法及疗效。方法 回顾性分析2008年6月—2019年6月首都医科大学三博脑科医院神经外科手术治疗的27例中颅窝脑膜瘤患者的临床资料,其中男10例,女17例;年龄30~67岁,平均年龄55.5岁;发病时间4个月至3年。27例患者侧裂静脉呈蝶顶窦优势引流者15例,非优势引流者12例。所有患者均经额颞筋膜间入路行脑膜瘤切除术。结果 27例中颅窝脑膜瘤患者中SimpsonⅡ级切除24例,Ⅲ级切除3例。术中3例蝶顶窦非优势引流者,因肿瘤包绕粘连,给予电凝切断。术后无1例死亡。术后1例因脑水肿加重行二次手术去骨瓣减压。随访2~13年,平均随访5.5年,无1例肿瘤复发。结论 中颅窝脑膜瘤常累及甚至包绕蝶顶窦引流静脉,术前要详细评估静脉引流情况,术中要重视该静脉的保护,锐性分离解剖保留引流静脉,才能减轻术后脑水肿。Objective To investigate and summarize the method and effect of protecting sphenoparietal sinus drainage vein in the operation of middle cranial fossa meningioma.Methods The clinical data of 27 patients with middle cranial fossa meningiomas were retrospectively analyzed, who underwent neurosurgery in Sanbo Brain Hospital, Capital Medical University from June 2008 to June 2019. There were 10 males and 17 females, aged from 30 to 67 years, with an average age of 55.5 years. The duration of disease lasted from 4 months to 3 years. Of the 27 patients, 15 cases had superior drainage of sphenoparietal sinus and 12 cases had non dominant drainage. Tumor resection was performed in all 27 patients via frontal-temporal interfascial approach.Results Simpson Grade Ⅱ resection was achieved in 24 cases and Simpson Grade Ⅲ resection in 3 cases. During the operation, 3 cases with non dominant drainage veins were cut off by electrocoagulation due to tumor wrapping and adhesion. One case underwent secondary operation to remove the bone flap decompression due to edema. All the patients had been followed-up postoperatively for 2 to 13 years with an average of 5.5 years. No tumor recurrence occurred, and no patients died during the operation.Conclusions Meningiomas in the middle cranial fossa often involves the drainage vein of the sphenoparietal sinus. The venous drainage should be evaluated carefullly before operation. More attention should be paid to the protection of the vein. Postoperative cerebral edema can be alleviated by sharp dissection and preservation of drainage veins.

关 键 词：蝶顶窦 引流静脉 中颅窝 脑膜瘤 显微手术 

分 类 号：R739.45[医药卫生—肿瘤]