上矢状窦完全闭塞型脑膜瘤完全切除

发布时间：2019-04-10 19:36

【摘要】：脑膜瘤(meningioma)一般属于良性肿瘤，在中枢神经系统最为常见。一般而言，脑膜瘤主要发生的部位有矢状窦旁、鞍区、大脑凸面等处，次要发生的部位为溴沟、蝶骨嵴、小脑角等处。其中，脑膜瘤大多数为WHO I级，WHO II级约占4.7%-7.2%，WHO III级约占1.0%-2.8%。WHO II级、WHO III级脑膜瘤，甚至包括少数WHO I级脑膜瘤在生长的过程中，往往侵及颅内静脉系统，一些常见的侵犯之处包括上矢状窦、海绵窦、中央沟静脉等。脑膜瘤发病率约占颅内肿瘤的13%-26%，其生长速度一般较为缓慢，通常高发于40-60岁的中年人群，男女发病率比例约为1:2左右。大多数脑膜瘤为良性肿瘤，仅2%-10%具有恶性生长行为。上矢状窦(superior sagittal sinus)为硬脑膜窦，位于大脑镰的附着缘，硬脑膜及硬脑膜窦，收集大脑半球上外侧面上部及内侧面上部的静脉血，以及通过蛛网膜粒回流的脑脊液，向后注入窦汇，，担负着调节颅内压力和引流颅内血液等重要功能。根据肿瘤的具体生长方式和它与上矢状窦周围组织的关系不同，可将其细分为8种类型，在此基础上，有学者将其分为3种情况。癫痫是上矢状窦完全闭塞性脑膜瘤最为常见的临床特征，半数以上的患者均表现出此类症状。其次为运动或感觉神经功能障碍，发生率可达40%，再次为头痛、精神异常、头部肿胀感，发生率分别为12%、10%、3%。另外，约46.3%的病人查体无神经系统阳性体征。本文总结2012年2月至2014年2月沈阳陆军总院神经外科梁勇组收治患者中符合上失状窦前、中1/3完全闭塞的患者，共计4例。其中手术患者3例，未手术患者1例（因家属考虑手术风险拒绝手术）。3例患者，男性患者2例，女性患者2例（1例未手术），最大年龄70岁，最小年龄30岁。其中，体检发现1例，首发症状为头痛1例，首发症状为癫痫1例，首发症状为肢体活动不灵1例。通过对病例进行深入分析，并在大量文献调研的基础上，对上矢状窦完全闭塞型脑膜瘤完全切除的术前检查（分型、血管造影表现、MRV表现、其它影像特征）、手术治疗（切除标准、术前准备、手术入路、肿瘤切除、受累矢状窦部肿瘤切除与矢状窦重建）、上矢状窦完全闭塞术中判断方法（窦腔夹闭试验）、显微技术的应用、术中出血的控制（动脉栓塞法、静脉放血法、术中降压法）、其它治疗方法（放射治疗、羟基脲化学治疗等）、术后康复（术后复发、患者康复）进行了详细的探讨，为上矢状窦完全闭塞型脑膜瘤完全切除提供了一定的指导意义。
[Abstract]:Meningioma (meningioma) is generally a benign tumor, the most common in the central nervous system. Generally speaking, the main sites of meningioma are parasagittal sinus, Sellar region, cerebral convex surface, bromine sulcus, sphenoid crest, cerebellar angle, etc. The main occurrence sites are bromine sulcus, sphenoid ridge, cerebellar angle and so on. Among them, the majority of meningiomas are WHO I grade, WHO II grade 4.7% ~ 7.2%, WHO III grade about 1.0%-2.8%.WHO II grade, WHO III meningioma, and even include a small number of WHO grade I meningioma in the course of growth, Often invading the intracranial venous system, some common lesions include the superior sagittal sinus, cavernous sinus, central sulcus vein and so on. The incidence of meningioma is about 13% / 26% of intracranial tumors. The growth rate of meningioma is generally slow. The incidence rate of meningioma is usually higher in the middle-aged people aged 40 years and 60 years old, and the incidence ratio of male and female is about 1:2. Most meningiomas are benign tumors, and only 2% of meningiomas have malignant growth behavior. The superior sagittal sinus (superior sagittal sinus) is the dural sinus, located at the attachment edge of the cerebral falx, the dural and dural sinuses, and the venous blood collected from the upper and upper lateral and medial sides of the cerebral hemisphere, as well as the cerebrospinal fluid flowing back through the arachnoid granule. Backward infusion of sinus sink, responsible for the regulation of intracranial pressure and drainage of intracranial blood and other important functions. According to the specific growth pattern of the tumor and its relationship with the tissue around the superior sagittal sinus, it can be subdivided into 8 types, on the basis of which, some scholars have divided it into three cases. Epilepsy is the most common clinical feature of complete occlusive meningioma of superior sagittal sinus, and more than half of the patients show such symptoms. The second was motor or sensory nerve dysfunction (40%), followed by headache, mental disorder and head swelling (12%, 10%, 3%, respectively). In addition, about 46.3% of the patients had no positive signs of nervous system during physical examination. From February 2012 to February 2014 in Liang Yong group of neurosurgery department of Shenyang Army General Hospital, 4 patients with anterior superior aphasia sinus occlusion and middle 1 ~ 3 complete occlusion were reviewed. Among them, 3 cases were operated on, 1 case was not operated, 3 cases were male, 2 cases were female, the maximum age was 70 years old, the minimum age was 30 years old, the operation risk was considered by their family members, 3 cases were male patients and 2 cases were female patients (1 case were not operated), the maximum age was 70 years old and the minimum age was 30 years. One case was found in physical examination, the first symptom was headache in 1 case, the first symptom was epilepsy in 1 case, the first symptom was limb inactivity in 1 case. Through in-depth analysis of the cases, and on the basis of a large number of literature research, the preoperative examination (classification, angiographic findings, MRV findings, other imaging features) of completely occlusive meningioma of the superior sagittal sinus was performed. Surgical treatment (criteria for resection, preoperative preparation, surgical approach, tumor resection, resection of involved sagittal sinus tumors and reconstruction of sagittal sinus), intraoperative judgement of complete closure of superior sagittal sinus (Sinus occlusion test), application of microscopic techniques, The control of intraoperative bleeding (arterial embolization, venous bleeding, intraoperative hypotension), other treatment methods (radiotherapy, hydroxyurea chemotherapy, etc.), postoperative rehabilitation (postoperative recurrence, patient rehabilitation) were discussed in detail. It provides some guidance for complete resection of completely occluded meningioma of superior sagittal sinus.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R739.45

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