窦镰旁脑膜瘤切除术中静脉保护及大脑镰重建  

Venous protection and cerebral falx reconstruction during resection of parasagittal and falcine meningioma

作　　者：唐晓平[1] 胡超[1] 赵龙[1] 彭华[1] 段宗锟 王跃龙[2] 徐建国[2] TANG Xiao-ping;HU Chao;ZHAO Long;PENG Hua;DUAN Zong-kun;WANG Yue-long;XU Jian-guo(Department of Neurosurgery,1.Affiliated Hospital of North Sichuan Medical College,Nanchong 637000;West China Hospital,Sichuan University,Chengdu 610041,Sichuan,China)

机构地区：[1]川北医学院附属医院神经外科,四川南充637000 [2]四川大学华西医院神经外科,四川成都610041

出　　处：《川北医学院学报》2025年第3期380-384,共5页Journal of North Sichuan Medical College

基　　金：四川省南充市科技项目(20SXQT0316);川北医学院附属医院科研发展计划项目(2022LC003)。

摘　　要：目的:探讨窦镰旁脑膜瘤手术切除术中静脉保护策略及大脑镰重建技术要点,提高窦镰旁脑膜瘤的手术安全性,改善预后。方法:回顾性分析56例窦镰旁脑膜瘤患者的临床资料,采用门诊随访的方式了解患者的恢复情况。总结静脉保护和大脑镰重建技术要点并结合文献进行讨论。结果:56例患者术后恢复良好,无死亡病例;其中52例患者术后3 h左右复查CT均无出血及严重脑水肿,4例患者有少许出血。8例患者术后3 d左右出现不同程度的对侧肢体偏瘫,13例患者发生继发性癫痫,经相应治疗后好转并得到控制。术前KPS评分为(81.5±6.7)分,随访2~3年,随访KPS评分为(90.3±5.2)分,所有患者未见明显的肿瘤复发、无严重肢体瘫痪和顽固性癫痫等相关后遗症。结论:累及矢状窦、大脑镰的脑膜瘤容易侵犯矢状窦及深部引流静脉,术前应行有效影像学检查明确肿瘤与血管的位置关系,做好术前预案;术中充分暴露肿瘤与周围血管情况,并尽可能保护引流静脉;切除的大脑镰应予以重建,总体效果良好。Objective:To summarize the strategies for venous protection and key techniques of falx reconstruction during the resection of parasagittal and falcine meningiomas,thereby improving surgical safety and prognosis.Methods:The Clinical data of 56 patients with parasagittal and falcine meningiomas were retrospectively reviewed.Patients' recovery was assessed via outpatient follow-up.Key technical points for venous protection and falx reconstruction were summarized and discussed alongside literature.Results:All 56 patients recovered well postoperatively,with no mortality.Among them,52 patients showed no hemorrhage or severe cerebral edema on CT scans at approximately 3 hours postoperatively,while 4 had minor hemorrhage.8 patients developed contralateral limb hemiplegia around postoperative day 3,and 13 experienced secondary epilepsy,all of which improved with treatment.The preoperative mean KPS score was 81.5±6.7.After 2~3 years of follow-up,the mean KPS score increased to 90.3±5.2.No tumor recurrence,severe paralysis,or intractable epilepsy was observed.Conclusion:Parasagittal and falcine meningiomas involving the sagittal sinus and deep draining veins require preoperative imaging to clarify tumor-vascular relationships and formulate surgical plans.Intraoperatively,adequate exposure of the tumor and surrounding vessels,meticulous protection of draining veins,and reconstruction of the resected falx are critical.These strategies ensure favorable overall outcome.

关 键 词：窦镰旁脑膜瘤 癫痫 偏瘫 显微外科 

分 类 号：R615[医药卫生—外科学]