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目的探讨侵犯上矢状窦脑膜瘤的手术治疗方法。方法回顾性分析黄山市人民医院神经外科2003年12月-2011年10月收治的侵犯上矢状窦的脑膜瘤患者,共14例,男性8例、女性6例,年龄34～63岁,平均49岁。颅内压增高者9例,癫痫发作3例,偏瘫等定位体征4例。肿瘤部位均为单侧。对14例患者采用显微手术切除,同时行受累上矢状窦壁切除加重建上矢状窦11例,受累上矢状窦部切除3例。结果 14例患者手术结果满意,术后恢复良好,无死亡病例。9例颅内压增高患者,术后头痛、呕吐等症状消失,3例癫痫患者术后癫痫发作缓解,4例术前偏瘫等定位体征患者,术后阳性体征明显改善或恢复正常。所有患者随访6个月～5年,1例患者术后脑膜瘤复发,行二次手术治愈,其余13例均未见复发。结论采用显微外科技术行上矢状窦旁脑膜瘤镜下全切除,同时行受累矢状窦切除,或上矢状窦壁切除加重建上矢状窦,可有效治疗侵犯上矢状窦的窦旁脑膜瘤。
Objective To investigate the surgical treatment of upper sagittal sinus meningiomas. Methods A total of 14 cases of meningioma invaded the superior sagittal sinus were retrospectively analyzed in Department of Neurosurgery, Huangshan People’s Hospital from December 2003 to October 2011. There were 8 males and 6 females, aged 34-63 years 49 years old. Intracranial pressure in 9 cases, 3 cases of seizures, hemiplegia and other signs of positioning in 4 cases. Tumor sites are unilateral. Fourteen patients underwent microsurgical resection. Elevated sagittal sinus resection was performed in 11 cases, and sagittal sinus was implanted in 11 cases. Three cases were involved in the sagittal sinus resection. Results The results of 14 patients were satisfactory, and the patients recovered well without death. In 9 patients with increased intracranial pressure, postoperative headache, vomiting and other symptoms disappeared. Postoperative epileptic seizures were relieved in 3 patients with epilepsy. Four patients with signs of preoperative hemiplegia showed significant improvement or returned to normal postoperative signs. All patients were followed up for 6 months to 5 years. One patient had recurrence of meningiomas after second operation, and no recurrence was found in the remaining 13 patients. Conclusions The microsurgical technique of subtotal sagittal sinus meningioma undergone total resection, simultaneous involvement of the sagittal sinus resection, or the superior sagittal sinus resection aggravated the superior sagittal sinus, which can effectively treat the violation of the superior sagittal sinus Sinus meningioma.