上矢狀竇完全閉塞型腦膜瘤完全切除
發(fā)布時(shí)間：2019-04-10 19:36
【摘要】：腦膜瘤(meningioma)一般屬于良性腫瘤，在中樞神經(jīng)系統(tǒng)最為常見。一般而言，腦膜瘤主要發(fā)生的部位有矢狀竇旁、鞍區(qū)、大腦凸面等處，次要發(fā)生的部位為溴溝、蝶骨嵴、小腦角等處。其中，腦膜瘤大多數(shù)為WHO I級(jí)，WHO II級(jí)約占4.7%-7.2%，WHO III級(jí)約占1.0%-2.8%。WHO II級(jí)、WHO III級(jí)腦膜瘤，甚至包括少數(shù)WHO I級(jí)腦膜瘤在生長(zhǎng)的過程中，往往侵及顱內(nèi)靜脈系統(tǒng)，一些常見的侵犯之處包括上矢狀竇、海綿竇、中央溝靜脈等。腦膜瘤發(fā)病率約占顱內(nèi)腫瘤的13%-26%，其生長(zhǎng)速度一般較為緩慢，通常高發(fā)于40-60歲的中年人群，男女發(fā)病率比例約為1:2左右。大多數(shù)腦膜瘤為良性腫瘤，僅2%-10%具有惡性生長(zhǎng)行為。 上矢狀竇(superior sagittal sinus)為硬腦膜竇，位于大腦鐮的附著緣，硬腦膜及硬腦膜竇，收集大腦半球上外側(cè)面上部及內(nèi)側(cè)面上部的靜脈血，以及通過蛛網(wǎng)膜粒回流的腦脊液，向后注入竇匯，，擔(dān)負(fù)著調(diào)節(jié)顱內(nèi)壓力和引流顱內(nèi)血液等重要功能。根據(jù)腫瘤的具體生長(zhǎng)方式和它與上矢狀竇周圍組織的關(guān)系不同，可將其細(xì)分為8種類型，在此基礎(chǔ)上，有學(xué)者將其分為3種情況。癲癇是上矢狀竇完全閉塞性腦膜瘤最為常見的臨床特征，半數(shù)以上的患者均表現(xiàn)出此類癥狀。其次為運(yùn)動(dòng)或感覺神經(jīng)功能障礙，發(fā)生率可達(dá)40%，再次為頭痛、精神異常、頭部腫脹感，發(fā)生率分別為12%、10%、3%。另外，約46.3%的病人查體無(wú)神經(jīng)系統(tǒng)陽(yáng)性體征。 本文總結(jié)2012年2月至2014年2月沈陽(yáng)陸軍總院神經(jīng)外科梁勇組收治患者中符合上失狀竇前、中1/3完全閉塞的患者，共計(jì)4例。其中手術(shù)患者3例，未手術(shù)患者1例（因家屬考慮手術(shù)風(fēng)險(xiǎn)拒絕手術(shù)）。3例患者，男性患者2例，女性患者2例（1例未手術(shù)），最大年齡70歲，最小年齡30歲。其中，體檢發(fā)現(xiàn)1例，首發(fā)癥狀為頭痛1例，首發(fā)癥狀為癲癇1例，首發(fā)癥狀為肢體活動(dòng)不靈1例。 通過對(duì)病例進(jìn)行深入分析，并在大量文獻(xiàn)調(diào)研的基礎(chǔ)上，對(duì)上矢狀竇完全閉塞型腦膜瘤完全切除的術(shù)前檢查（分型、血管造影表現(xiàn)、MRV表現(xiàn)、其它影像特征）、手術(shù)治療（切除標(biāo)準(zhǔn)、術(shù)前準(zhǔn)備、手術(shù)入路、腫瘤切除、受累矢狀竇部腫瘤切除與矢狀竇重建）、上矢狀竇完全閉塞術(shù)中判斷方法（竇腔夾閉試驗(yàn)）、顯微技術(shù)的應(yīng)用、術(shù)中出血的控制（動(dòng)脈栓塞法、靜脈放血法、術(shù)中降壓法）、其它治療方法（放射治療、羥基脲化學(xué)治療等）、術(shù)后康復(fù)（術(shù)后復(fù)發(fā)、患者康復(fù)）進(jìn)行了詳細(xì)的探討，為上矢狀竇完全閉塞型腦膜瘤完全切除提供了一定的指導(dǎo)意義。
[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.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R739.45
本文編號(hào)：2456066
[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.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R739.45
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