矢状窦旁脑膜瘤的侧支静脉分型对术中静脉处理的指导价值  

The guiding value of collateral vein classification in parasagittal meningiomas for intraoperative vein management

作　　者：蔡青 王首杰 秦怀洲 冯达云 Cai Qing;Wang Shoujie;Qin Huaizhou;Feng Dayun(Department of Neurosurgery,Tangdu Hospital of Air Force Medical University,Xi′an 710038,China)

机构地区：[1]空军军医大学唐都医院神经外科,西安710038

出　　处：《中华神经外科杂志》2022年第9期884-888,共5页Chinese Journal of Neurosurgery

基　　金：国家自然科学基金(81971129)。

摘　　要：目的探讨矢状窦旁脑膜瘤的侧支静脉分型对术中静脉处理的指导作用。方法回顾性分析2017年3月至2020年7月空军军医大学唐都医院神经外科行手术切除的68例矢状窦旁脑膜瘤患者的临床资料。根据术前头颅磁共振静脉成像(MRV)检查结果,结合术中瘤周侧支静脉的回流情况对所有患者的瘤周侧支静脉分型,并根据分型结果指导术中对静脉的处理。根据Simpson分级评估肿瘤的切除程度。术后常规行头颅CT和MRI检查,明确肿瘤的切除程度以及静脉性梗死的发生情况。术后患者行临床随访,采用格拉斯哥预后评级(GOS)评估患者的神经功能预后。结果68例患者的瘤周侧支静脉可分为4型:(1)无吻合型(12例):静脉围绕肿瘤走行;(2)端-端吻合型(17例):闭塞窦前、后静脉相互沟通;(3)浅静脉吻合型(25例):闭塞窦瘤周侧支静脉主要通过浅静脉回流;(4)深静脉吻合型(14例):闭塞窦瘤周侧支静脉主要通过深静脉回流。68例患者中,术中意外或有目的损伤瘤周侧支静脉共12例,4例(5.9%)发生继发静脉性脑梗死。Simpson分级Ⅰ级切除18例,Ⅱ级24例,Ⅲ级15例,Ⅳ级11例。术后68例患者均随访6个月,末次随访时,GOSⅤ级66例,Ⅳ级1例,Ⅲ级1例。结论瘤周侧支静脉分型对矢状窦旁脑膜瘤手术中静脉的取舍具有参考价值,根据分型情况指导术中对瘤周侧支静脉的处理,有助于减少或避免因静脉损伤继发静脉性梗死引起的并发症。Objective To explore the guiding value of collateral vein classification in parasagittal meningiomas for intraoperative vein management.Methods The clinical data of 68 patients with parasagittal meningioma who underwent surgical resection from March 2017 to July 2020 at the Department of Neurosurgery,Tangdu Hospital,Air Force Medical University were retrospectively analyzed.The peritumoral collateral veins of all patients were classified according to the results of preoperative magnetic resonance venography(MRV)examination and the drainage of collateral veins around the tumor during the operation,and the management of the veins during the operation was guided according to the classification results.The extent of tumor resection was assessed according to the Simpson grading system.Postoperative CT and MRI were routinely performed to determine the extent of tumor resection and the occurrence of venous infarction.The patients underwent clinical follow-up after surgery,and the neurological outcome of the patients was assessed by the Glasgow Outcome Scale(GOS).Results The peritumoral collateral veins in 68 cases were divided into 4 types:(1)No anastomosis(12 cases):veins surrounded the tumor.(2)End-to-end anastomosis(17 cases):The anterior and posterior veins of the occluded sinus communicated with each other.(3)Superficial vein anastomosis(25 cases):Occluded sinus peritumoral collateral veins mainly drained into superficial veins.(4)Deep vein anastomosis(14 cases):Occluded sinus peritumoral collateral veins mainly drained into deep veins.Intraoperative accidental or purposeful injury to peritumoral collateral veins occurred in 12 cases,and complications related to secondary vein injury occurred in 4 cases(5.9%).According to the Simpson classification,18 cases were gradeⅠ,24 cases were gradeⅡ,15 cases were gradeⅢ,and 11 cases were gradeⅣ.All 68 patients were followed up for 6 months after operation.At the last follow-up,the GOS score was as follows:66 cases were gradeⅤ,1 case was gradeⅣ,and 1 case was grad

关 键 词：脑膜瘤 上矢状窦 侧支循环 分型 静脉性梗死 

分 类 号：R739.45[医药卫生—肿瘤]