摘要
目的探讨上矢状窦旁镰旁中1／3脑膜瘤的手术策略，提高肿瘤切除率和手术效果。方法对5年内手术治疗74例上矢状窦旁镰旁中1／3脑膜瘤进行了回顾性研究，分析了临床、影像学和手术资料。并对患者进行了随访。结果74例中，SimpsonⅡ级切除67例，SimpsonⅢ级切除7例，没有SimpsonⅠ级切除。术中所有病例矢状窦及中央沟静脉保护完好，皮层供血血管未损伤。肿瘤囊内分块切除的66例病例（SimpsonⅡ级切除61例，SimpsonⅢ级切除5例），术后患者对侧下肢肌力正常或短暂的力弱。肿瘤翻转并分块切除8例病例（SimpsonⅡ级切除6例，SimpsonⅢ级切除2例），1例对侧下肢完全性瘫痪。7例病例术后患者对侧下肢肌力正常或短暂的力弱。随访6个月～4年2个月，失访4例．未见肿瘤复发，手术后对侧下肢力弱的病例1个月后功能恢复正常，手术后对侧下肢完全性瘫痪的1例病例6个月后肌力恢复到Ⅳ级，无死亡病例。结论显微镜下肿瘤分块切除、保护好中央静脉、处理好矢状窦、避免脑皮质损伤是提高肿瘤切除率、保护神经功能的最佳方法。
Objective To discuss the surgical strategy of parasagittal and falcial meningiomas in the middle 1/3 cortex area and raise resective rates of tumors and surgical effects. Methods The clinical, imaging and operative data of 74 cases of parasagittal and falcial meningiomas in the middle cortex area which underwent operation were reviewed and followed up. Results Of 74 tunors, 67 were resected with SimpsonⅡ grade,7 with Simpson Ⅲ, none of them with SimpsonⅠ . Superior sagittal sinus and the vein of central sulcus and feeders of cortex were reserved well. Severe brain injury was not occurred in 66 cases with tumors debulking（Simpson 1 61 cases, Simpson lll 5 cases）, the neuro-functions of patients were normal or transient slight weakness of contralateral lower extremities postoperatively. Tumors of 8 cases were ＂turned over＂ and resected by piecemeal （Simpson 11 6 cases, Simpson Ⅲ 2 cases）, weakness and paralysis of contralateral lower extremities occurred in 7 cases and 1 cases respectively after surgery. Followed-up ranged from 6 months to 4 years and 2 months, 4 cases were lost to follow-up. Neuro-function of all cases with weakness of contralateral lower extremities recovered after one month. Muscle strength of the cases with paralysis of contralateral extremity recovered to grade Ⅳ6 months later, no recurrence and death. Conclusion The measures, including piecemeal tumor resected microsugically, good protection of the vein of central sulcus, excellent management of superior sagittal sinus, and avoiding damage to functional cerebral cortex during operations, are best ways for raising the tumor resection rate and ncuro-function reserved.
出处
《中华显微外科杂志》
CSCD
北大核心
2008年第5期328-331,I0004,共5页
Chinese Journal of Microsurgery
关键词
脑膜瘤
上矢状窦
显微外科手术
Meningioma
Superior sagittal sinus
Microsurgical operation
