侵及矢狀竇的中央?yún)^(qū)腦膜瘤顯微手術(shù)治療方法的探究
發(fā)布時(shí)間：2020-08-25 15:14
【摘要】：目的:上矢狀竇旁尤其是靠近中央?yún)^(qū)的腦膜瘤,往往由于腫瘤較大,造成上矢狀竇不同程度的狹窄或閉塞,引起大腦皮層引流靜脈回流障礙,造成不同程度的神經(jīng)功能障礙。探究侵及矢狀竇旁腦膜瘤的手術(shù)方法,對(duì)保護(hù)正常的腦組織及靜脈回流系統(tǒng)具有重要價(jià)值,對(duì)術(shù)后神經(jīng)功能的恢復(fù)具有重要的意義。方法:選取河北醫(yī)科大學(xué)第二醫(yī)院神經(jīng)外科2017年至2018年間位于中央?yún)^(qū)矢狀竇旁腦膜瘤患者32例,通過(guò)影像學(xué)資料分析,根據(jù)侵及矢狀竇的程度,分為5組。均通過(guò)神經(jīng)顯微手術(shù)治療,比較患術(shù)前及術(shù)后KPS評(píng)分,并通過(guò)統(tǒng)計(jì)學(xué)分析。結(jié)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。手術(shù)前后統(tǒng)計(jì)KPS評(píng)分,具有統(tǒng)計(jì)學(xué)意義(P0.05)。結(jié)論:對(duì)位于中央?yún)^(qū)矢狀竇旁腦膜瘤的患者,合理的手術(shù)方法的選擇對(duì)回流靜脈系統(tǒng)及腦神經(jīng)功能保護(hù)具有重要意義。
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2019
【分類號(hào)】：R739.45
【圖文】：
圖1.Sindou 分型示意圖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
圖3.上矢狀竇旁腦膜瘤 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. 手術(shù)治療策略的探討為了便于對(duì)手術(shù)風(fēng)險(xiǎn)進(jìn)行評(píng)價(jià)，Sindou[1-4]根據(jù)腦膜瘤的生長(zhǎng)方式及上矢狀竇受侵犯的程度，將其分為6種類型（Fig.1），然而此種分類方法
圖4.瘤周3種引流靜脈的類型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. 不足之處當(dāng)然本研究尚有一些不足之處，由于樣本量較小，得出的結(jié)論可能存在一定的誤差，此外，本研究未對(duì)病理、放療等因素納入研究。應(yīng)加強(qiáng)多學(xué)科合作，共同探討，全方位進(jìn)行研究，此次研究雖未對(duì)病理及放療等因
本文編號(hào)：2803857
【學(xué)位授予單位】：河北醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2019
【分類號(hào)】：R739.45
【圖文】：
圖1.Sindou 分型示意圖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
圖3.上矢狀竇旁腦膜瘤 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. 手術(shù)治療策略的探討為了便于對(duì)手術(shù)風(fēng)險(xiǎn)進(jìn)行評(píng)價(jià)，Sindou[1-4]根據(jù)腦膜瘤的生長(zhǎng)方式及上矢狀竇受侵犯的程度，將其分為6種類型（Fig.1），然而此種分類方法
圖4.瘤周3種引流靜脈的類型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. 不足之處當(dāng)然本研究尚有一些不足之處，由于樣本量較小，得出的結(jié)論可能存在一定的誤差，此外，本研究未對(duì)病理、放療等因素納入研究。應(yīng)加強(qiáng)多學(xué)科合作，共同探討，全方位進(jìn)行研究，此次研究雖未對(duì)病理及放療等因
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