本文選題：上矢狀竇旁腦膜瘤 + 側(cè)支循環(huán)�。� 參考：《福建醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的 1.通過VR技術(shù)了解竇旁腦膜瘤顱內(nèi)靜脈直徑及數(shù)目的變化，推測上矢狀竇旁腦膜瘤患者靜脈循環(huán)代償通路的建立，為上矢狀竇旁腦膜瘤術(shù)中靜脈保護(hù)、降低復(fù)發(fā)率及并發(fā)癥提供指導(dǎo)。 2.探討術(shù)前應(yīng)用3D CE-MRV及VR技術(shù)評估上矢狀竇旁腦膜瘤的臨床意義,并總結(jié)上矢狀竇旁腦膜瘤手術(shù)治療的經(jīng)驗(yàn)及教訓(xùn)。 資料和方法 ①收集福建醫(yī)科大學(xué)�？偱R床學(xué)院在2011年10月～2014年3月收治的48例擬行手術(shù)的上矢狀竇旁腦膜瘤患者，視為腫瘤組；及無顱內(nèi)靜脈病變的三叉神經(jīng)痛和面肌痙攣患者20例，視為對照組；所有患者均行3D CE-MRV；②將影像學(xué)資料導(dǎo)入VR工作站重建相關(guān)解剖，評估側(cè)支循環(huán)、腫瘤位置及侵襲程度；③在3D視角下測量SSS兩側(cè)皮質(zhì)靜脈的直徑、數(shù)目及SSV、VT、VL、GCV、ISS、StS、TS、SS等靜脈直徑；④對比腫瘤組與對照組之間，不同側(cè)支循環(huán)、腫瘤位置及侵襲程度與對照組之間靜脈直徑及數(shù)目的差異；⑤對48例已行上矢狀竇旁腦膜瘤切除的患者進(jìn)行隨訪，并收集圍手術(shù)期靜脈處理方法及預(yù)后相關(guān)因素；⑥整體分析本組資料的并發(fā)癥、手術(shù)死亡率及復(fù)發(fā)率，并根據(jù)不同靜脈竇處理方案分析各靜脈竇處理組相關(guān)的臨床資料。 結(jié)果 ①48例PSM一般情況 7例PSM位于上矢狀竇前1/3段，31例位于SSS中1/3段，10例位于SSS后1/3段；靜脈竇侵襲分級1-2級24例，3-4級及5-6級各有12例；未形成側(cè)支循環(huán)23例，1級側(cè)支循環(huán)9例，側(cè)支循環(huán)3級16例。 ②PSM與對照組顱內(nèi)靜脈直徑及數(shù)目的比較 PSM組與正常對照組僅SSS后1/3段直徑存在統(tǒng)計(jì)學(xué)差異(P＜0.05)，分別(2.07±0.84)mm和(2.64±0.97)mm；其余各顱內(nèi)靜脈直徑及數(shù)目均無統(tǒng)計(jì)學(xué)差異(p＞0.05)； ③不同位置的PSM與對照組顱內(nèi)靜脈直徑及數(shù)目的比較 SSS前1/3段組與正常對照組間，顱內(nèi)各靜脈直徑和數(shù)目無統(tǒng)計(jì)學(xué)差異(P＞0.05)；SSS中1/3段組中，僅SSS后1/3段橋靜脈和VL直徑較對照組數(shù)值小，分別為(2.11±0.79)mm[對照組(2.64±0.97)mm]、(2.16±0.35)mm[對照組(2.41±0.35)mm]，，差異具有統(tǒng)計(jì)學(xué)意義(P＜0.05)；SSS后1/3組中，SSS后1/3段橋靜脈數(shù)目、TS直徑較正常對照組數(shù)值小，分別為(1.60±0.70)[對照組(2.80±1.58)]、(4.54±1.26)mm[對照組(5.70±0.90)mm]，SSV直徑較對照組數(shù)值大，為(2.90±0.57)mm[對照組(2.32±0.45)mm]，差異均具有統(tǒng)計(jì)學(xué)意義(P＜0.05)；SSS中1/3組較SSS后1/3段組的SSS后1/3段橋靜脈數(shù)目多(P＜0.05)，分別為(2.59±1.30)支、(1.60±0.70)支。 ④不同侵襲程度的PSM與對照組顱內(nèi)靜脈直徑及數(shù)目的比較 將48例PSM按照不同侵襲程度分為1-2級組、3-4級組和5-6級組；1-2級組與正常對照組間，顱內(nèi)各靜脈直徑和數(shù)目無統(tǒng)計(jì)學(xué)差異(P＞0.05)；3-4級組與正常對照組間，僅SSS前1/3段橋靜脈數(shù)目較正常組小，為(3.00±1.41)支[對照組(4.60±1.70)支]，差異具有統(tǒng)計(jì)學(xué)意義(P＜0.05)；5-6級組中，SSS后1/3段橋靜脈、TS直徑較正常對照組數(shù)值小，分別為(1.53±1.14)mm[對照組(2.64±0.97)mm]、(4.16±1.10)mm[對照組(5.70±0.90)mm]，差異均具有統(tǒng)計(jì)學(xué)意義(P＜0.05)；兩兩比較三組之間靜脈直徑及數(shù)目，三組各靜脈數(shù)值均無統(tǒng)計(jì)學(xué)差異(P＞0.05)。 ⑤不同側(cè)支循環(huán)的PSM與對照組顱內(nèi)靜脈直徑及數(shù)目的比較 將48例PSM按照不同側(cè)支循環(huán)分級分為0級組、1級組和3級組；0級組與正常對照組間，顱內(nèi)各靜脈直徑和數(shù)目無統(tǒng)計(jì)學(xué)差異(P＞0.05)；1級組與正常對照組間，僅VL、TS較對照組小，分別為(2.06±0.21)mm[對照組(2.41±0.35)mm]、(4.71±1.19)mm[對照組(5.70±0.90)mm]，差異具有統(tǒng)計(jì)學(xué)意義(P＜0.05)；3級組中，TS直徑較正常對照組數(shù)值小，分別為(4.42±1.08)mm[對照組(5.70±0.90)mm]，SSV直徑較對照組大，為(2.83±0.58)mm[對照組(2.32±0.45)mm]，差異均具有統(tǒng)計(jì)學(xué)意義(P＜0.05)；兩兩比較三組之間靜脈直徑及數(shù)目，三組各靜脈數(shù)值均無統(tǒng)計(jì)學(xué)差異(P＞0.05)。 ⑥48例腦膜瘤圍手術(shù)期及隨訪情況 48例擬行手術(shù)治療的上矢狀竇旁腦膜瘤患者，術(shù)后失訪4例，隨訪時間2-46個月；納入44例，其中男17例，女27例，年齡27~85歲,44例PSM中，Simpson分級I/II切除為41例(93.18%)，側(cè)支循環(huán)3級為16例(36.36%)，手術(shù)后新增神經(jīng)功能障礙或原癥狀惡化9例，永久性神經(jīng)功能障礙6例(13.64%)。3例患者術(shù)后出現(xiàn)靜脈竇血栓形成(6.82%)，2例好轉(zhuǎn)出院；死亡1例(2.27%)。復(fù)發(fā)1例(2.27%)。 ⑦不同靜脈竇處理方案PSM預(yù)后情況 44例上矢狀竇旁腦膜瘤根據(jù)術(shù)前侵襲程度及側(cè)支循環(huán)分級，共9例術(shù)中SSS采取離斷，預(yù)后不良率33.33%；3例術(shù)中開放SSS，切除腫瘤后，修補(bǔ)或直接縫合SSS，預(yù)后不良1例(33.33%)；32例術(shù)中采取電凝上矢狀竇壁，2例預(yù)后不佳(6.25%)；三者之間采用Fisher精確概率法計(jì)算，三者之間預(yù)后不良無統(tǒng)計(jì)學(xué)差別(P＞0.05)。對3種不同靜脈竇處理方法預(yù)后不良影響因素分析，各組均未見統(tǒng)計(jì)學(xué)差異(P＞0.05)。 結(jié)論 1.PSM侵襲靜脈竇主要引起SSS后1/3段BrV直徑及數(shù)目的改變，特別是在腫瘤位于SSS后1/3段時，其對SSS后1/3段BrV影響最大。 2. PSM侵襲SSS后導(dǎo)致VL、SSS橋靜脈數(shù)目、直徑的減少，SSV直徑的增加。 3. PSM侵襲SSS后可能導(dǎo)致VL、TS、SSS橋靜脈引流減少，顱內(nèi)靜脈血流主要通過SSV引流，匯入蝶頂靜脈竇和海綿竇，最終引流出顱。 4.術(shù)前對側(cè)支循環(huán)、侵襲程度及腫瘤位置進(jìn)行分級評估，了解PSM患者靜脈循環(huán)狀態(tài)，有助于指導(dǎo)手術(shù)方式選擇，改善患者預(yù)后。 5.聯(lián)合使用VR技術(shù)及3D CE-MRV術(shù)前評估顱內(nèi)靜脈循環(huán)狀態(tài)及腫瘤周圍結(jié)構(gòu)，有助于選擇適宜的手術(shù)術(shù)式，減少靜脈損傷，改善患者預(yù)后。
[Abstract]:objective
1. the changes in the intracranial venous diameter and number of paranantral meningiomas were detected by VR technique, and the establishment of the compensatory pathway in the upper sagittal meningioma was expected to provide guidance for the protection of the vein in the superior sagittal paranantral meningioma and the reduction of the recurrence rate and complications.
2. to explore the clinical significance of preoperative 3D CE-MRV and VR techniques in the evaluation of superior parasagittal meningiomas, and to summarize the experience and lessons of surgical treatment for parasagittal meningiomas.
Information and methods
(1) 48 cases of superior sagittal paranasal meningioma who were treated from October 2011 to March 2014 at the General Clinical College of Fujian Medical University were treated as tumor group, and 20 cases of trigeminal neuralgia and hemifacial spasm without intracranial venous disease were treated as control group; all patients were treated with 3D CE-MRV; 2. The imaging data were introduced into VR The workstation reconstruction related anatomy, evaluation of collateral circulation, tumor location and invasion degree; (3) measuring the diameter of the cortical veins in both sides of SSS, the number and the diameter of SSV, VT, VL, GCV, ISS, StS, TS, SS and other venous diameters in the 3D perspective; (4) compare the circulation of different side branches, tumor location and invasion between the tumor group and the control group and the venous diameter between the control group and the control group. The differences in the number of patients were followed up in 48 patients who had been excised by the superior sagittal meningioma, and the perioperative venous treatment and prognosis related factors were collected. 6. The overall analysis of the complications of the data, the mortality and recurrence rate of the operation, and the analysis of the related clinical trials in the different venous sinus treatment groups according to the different venous sinus treatments. Information.
Result
The general situation of 48 cases of PSM
7 cases of PSM were located in the 1/3 segment of the superior sagittal sinus, 31 in 1/3 segment in SSS, 10 in 1/3 segment of SSS, 24 in grade 1-2 in venous sinus invasion, 12 in Grade 5-6, and 23 in no collateral circulation, 9 in 1 collateral circulation, and 3 in collateral circulation 3.
Comparison of diameter and number of intracranial veins between PSM and control group
The diameter of 1/3 segment in group PSM and normal control group was statistically different (P < 0.05) (P < 0.05), respectively (2.07 + 0.84) mm and (2.64 + 0.97) mm, and the other intracranial venous diameters and numbers were not statistically different (P > 0.05).
Comparison of the diameter and number of intracranial veins in different locations of PSM and control group
There was no significant difference in the diameter and number of intracranial veins between the pre SSS 1/3 group and the normal control group (P > 0.05), and in the 1/3 group of SSS, the diameter of the bridge vein and VL in the 1/3 segment was smaller than that of the control group, which was (2.11 + 0.79) mm[control group (2.64 + 0.97) mm], (2.16 + 0.35) mm[control group (2.41 + 0.35) mm], the difference was statistically significant (0.05 In group 1/3 after SSS, the number of bridge veins of 1/3 segment after SSS was smaller than that of normal control group, which was (1.60 + 0.70) [control group (2.80 + 1.58)], (4.54 + 1.26) mm[control group (5.70 + 0.90) mm], SSV diameter was larger than that of control group, and (2.90 + 0.57) mm[pairs (2.32 + 0.45) mm], the difference was statistically significant (P < < < < < < < < P <). Compared with SSS, there were more 1/3 segment bridging veins after 1/3 in group SSS (P < 0.05), respectively (2.59 + 1.30) and (1.60 + 0.70).
(4) comparison of the diameter and number of intracranial veins between PSM with different invasiveness and control group.
48 cases of PSM were divided into 1-2 grade group, 3-4 class group and 5-6 grade group according to different invasion degree. There was no statistical difference between the diameter and number of intracranial veins between the 1-2 group and the normal control group (P > 0.05). The number of the 3-4 group and the normal control group was smaller than the normal group, which was (3 + 1.41) Branch [4.60 + 1-2], and the difference has the difference. There were statistical significance (P < 0.05); in the 5-6 grade group, the 1/3 segment of the bridge vein after SSS was smaller than that of the normal control group, respectively (1.53 + 1.14) mm[control group (2.64 + 0.97) mm], (4.16 + 1.10) mm[control group (5.70 + 0.90) mm], the difference was statistically significant (P < 0.05), 22 compared the diameter and number of venous between three groups, and the number of various veins among the three groups. There was no statistical difference between the values (P > 0.05).
Comparison of diameter and number of intracranial veins between PSM with different collateral circulation and control group
48 cases of PSM were divided into 0 grade group, 1 grade group and 3 grade group according to different collateral circulation. There was no statistical difference between the diameter and number of intracranial veins between the 0 group and the normal control group (P > 0.05), the 1 group and the normal control group, only VL and TS were smaller than the control group, respectively (2.06 + 0.21) mm[control group (2.41 + 0.35) mm], (4.71 + 1.19) mm[control group (4.71 + 1.19) mm[control group (4.71 + 1.19) (4.71) mm[control group (4.71 + 1.19) (4.71 + 1.19) mm[control group (4.71 + 1.19) (4.71 + 1.19) mm[control group (4.71 + 1.19) (4.71 + 1.19) mm[control group .90) mm], the difference was statistically significant (P < 0.05); in the 3 grade group, the diameter of TS was smaller than that of the normal control group, respectively (4.42 + 1.08) mm[control group (5.70 + 0.90) mm], SSV diameter larger than the control group, (2.83 + 0.58) mm[control group (2.32 + 0.45) mm], and the difference was statistically significant (P < 0.05); 22 compared the diameter and number of venous between three groups of three groups. There was no significant difference in the number of veins between the three groups (P > 0.05).
The perioperative period and follow-up of 48 cases of meningioma
48 cases of superior sagittal paranus meningioma were treated with surgical treatment, and 4 cases were lost and followed up for 2-46 months. 44 cases were included in 17 men, 27 women, age 27~85 years, 44 PSM, 41 cases (93.18%) with Simpson grading I/II resection, and 3 level of collateral circulation in 16 (36.36%). There were 6 cases (13.64%) of sexual nerve dysfunction (.3). Venous sinus thrombosis (6.82%) occurred after operation, 2 cases recovered and discharged, 1 cases died (2.27%), 1 cases recurred (2.27%).
The prognosis of PSM with different venous sinus treatment
44 cases of superior sagittal paranasal meningioma were classified according to the degree of preoperative invasion and collateral circulation, and 9 cases of SSS were disconnected during operation, and the rate of poor prognosis was 33.33%. 3 cases opened SSS during operation, after resection of the tumor, repair or direct suture of SSS, and 1 cases (33.33%) with poor prognosis; 32 cases were treated with electrocoagulation on sagittal sinus wall and 2 cases with poor prognosis (6.25%); three were used among three. There was no statistically significant difference in prognosis between the three cases (P > 0.05) by the Fisher precision probability method (P > 0.05). There was no statistically significant difference in the prognostic factors of 3 different venous sinus treatments (P > 0.05).
conclusion
1.PSM invasion of venous sinus mainly caused changes in the diameter and number of 1/3 segment BrV after SSS, especially when the tumor was located at 1/3 segment after SSS, which had the greatest effect on 1/3 BrV after SSS.
2. PSM invasion of SSS resulted in a decrease in the number of VL, SSS bridging veins, and an increase in the diameter of SSV.
3. PSM invasion of SSS may lead to the decrease of VL, TS, SSS bridge venous drainage. The intracranial venous blood flow is mainly through SSV drainage, into the sphenoid antrum and cavernous sinus, and eventually drainage of the cranium.
4. to evaluate the collateral circulation, the degree of invasion and the location of the tumor before operation. To understand the venous circulation of PSM patients, it is helpful to guide the selection of surgical methods and improve the prognosis of the patients.
5. the combined use of VR technology and 3D CE-MRV preoperative assessment of intracranial venous circulation and the surrounding structure of the tumor can help to select appropriate surgical procedures, reduce venous injury and improve the prognosis of the patients.
【學(xué)位授予單位】：福建醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R739.45

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