侵及矢状窦的中央区脑膜瘤显微手术治疗方法的探究
发布时间：2020-08-25 15:14
【摘要】：目的:上矢状窦旁尤其是靠近中央区的脑膜瘤,往往由于肿瘤较大,造成上矢状窦不同程度的狭窄或闭塞,引起大脑皮层引流静脉回流障碍,造成不同程度的神经功能障碍。探究侵及矢状窦旁脑膜瘤的手术方法,对保护正常的脑组织及静脉回流系统具有重要价值,对术后神经功能的恢复具有重要的意义。方法:选取河北医科大学第二医院神经外科2017年至2018年间位于中央区矢状窦旁脑膜瘤患者32例,通过影像学资料分析,根据侵及矢状窦的程度,分为5组。均通过神经显微手术治疗,比较患术前及术后KPS评分,并通过统计学分析。结果:32例患者中,Ⅰ型12例;Ⅱ型10例;Ⅲ型4例;Ⅳ型2例;Ⅴ型4例。手术前后统计KPS评分,具有统计学意义(P0.05)。结论:对位于中央区矢状窦旁脑膜瘤的患者,合理的手术方法的选择对回流静脉系统及脑神经功能保护具有重要意义。
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2019
【分类号】：R739.45
【图文】：
图1.Sindou 分型示意图Sindou Classification diagram.TypeI:meningioma adheres to l surface of the venous sinus wall;TypeII: proximal sinus wall Ad;TypeIII: proximal venous sinus wall is completely invaded;Typn of proximal venous sinus wall and venous sinus roof;TypeV: onlyateral venous sinus wall is not invaded;TypeVI: complete occlusious
图3.上矢状窦旁脑膜瘤 MR 成像及其引流Fig.3 MR imaging and drainage of para-sagittal meningioma.A.MRt1-weighted imaging revealed type I superior sagittal sinus invasion.B.MRt2-weighted imaging shows the anterior portion of thetumor.C.three-dimensional ce-mrv showed compression of multiple corticalveins with end-to-end anastomosis.D. sagittal MRV has no lateral branchesconnecting the superior sagittal sinus to the deep venous sinus.E.mrt1-weighted imaging revealed type 3 superior sagittal sinus invasioninvolving the skull.F.T2 weighted imaging.G.three-dimensional ce-mrvshowed multiple bilateral compressed cortical veins.H. sagittal MRV revealedthe absence of lateral branches in the superior sagittal sinus and deep vein2. 手术治疗策略的探讨为了便于对手术风险进行评价，Sindou[1-4]根据脑膜瘤的生长方式及上矢状窦受侵犯的程度，将其分为6种类型（Fig.1），然而此种分类方法
图4.瘤周3种引流静脉的类型Fig.4 3 types of drainage veins around the tumor.A.unidirectional anastomosis,which starts from the surface of cerebral cortex and flows upward to thesuperior sagittal sinus;B. tumor-terminal anastomosis type, which starts fromthe inside of the tumor, runs on the surface of cerebral cortex, and drains oneor more superficial venous systems;C. End-to-end anastomosis, one end isconnected to the superior sagittal sinus, with or without branches of the mainvein, and the other end is connected to one or more superficial cerebral veins,such as Labbe vein, lateral fissure vein, transverse sinus, etc3. 不足之处当然本研究尚有一些不足之处，由于样本量较小，得出的结论可能存在一定的误差，此外，本研究未对病理、放疗等因素纳入研究。应加强多学科合作，共同探讨，全方位进行研究，此次研究虽未对病理及放疗等因
本文编号：2803857
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2019
【分类号】：R739.45
【图文】：
图1.Sindou 分型示意图Sindou Classification diagram.TypeI:meningioma adheres to l surface of the venous sinus wall;TypeII: proximal sinus wall Ad;TypeIII: proximal venous sinus wall is completely invaded;Typn of proximal venous sinus wall and venous sinus roof;TypeV: onlyateral venous sinus wall is not invaded;TypeVI: complete occlusious
图3.上矢状窦旁脑膜瘤 MR 成像及其引流Fig.3 MR imaging and drainage of para-sagittal meningioma.A.MRt1-weighted imaging revealed type I superior sagittal sinus invasion.B.MRt2-weighted imaging shows the anterior portion of thetumor.C.three-dimensional ce-mrv showed compression of multiple corticalveins with end-to-end anastomosis.D. sagittal MRV has no lateral branchesconnecting the superior sagittal sinus to the deep venous sinus.E.mrt1-weighted imaging revealed type 3 superior sagittal sinus invasioninvolving the skull.F.T2 weighted imaging.G.three-dimensional ce-mrvshowed multiple bilateral compressed cortical veins.H. sagittal MRV revealedthe absence of lateral branches in the superior sagittal sinus and deep vein2. 手术治疗策略的探讨为了便于对手术风险进行评价，Sindou[1-4]根据脑膜瘤的生长方式及上矢状窦受侵犯的程度，将其分为6种类型（Fig.1），然而此种分类方法
图4.瘤周3种引流静脉的类型Fig.4 3 types of drainage veins around the tumor.A.unidirectional anastomosis,which starts from the surface of cerebral cortex and flows upward to thesuperior sagittal sinus;B. tumor-terminal anastomosis type, which starts fromthe inside of the tumor, runs on the surface of cerebral cortex, and drains oneor more superficial venous systems;C. End-to-end anastomosis, one end isconnected to the superior sagittal sinus, with or without branches of the mainvein, and the other end is connected to one or more superficial cerebral veins,such as Labbe vein, lateral fissure vein, transverse sinus, etc3. 不足之处当然本研究尚有一些不足之处，由于样本量较小，得出的结论可能存在一定的误差，此外，本研究未对病理、放疗等因素纳入研究。应加强多学科合作，共同探讨，全方位进行研究，此次研究虽未对病理及放疗等因
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