CAJ | 학술논문

目的探讨上矢状窦旁镰旁中1/3脑膜瘤的手术策略,提高肿瘤切除率和手术效果.方法对5年内手术治疗74例上矢状窦旁镰旁中1/3脑膜瘤进行了回顾性研究,分析了临床、影像学和手术资料,并对患者进行了随访.结果 74例中,SimpsonⅡ级切除67例,Simpson Ⅲ级切除7例,没有SimpsonⅠ级切除.术中所有病例矢状窦及中央沟静脉保护完好,皮层供血血管未损伤.肿瘤囊内分块切除的66例病例(Simpson Ⅱ级切除61例,Simpson Ⅲ级切除5例),术后患者对侧下肢肌力正常或短暂的力弱.肿瘤翻转并分块切除8例病例(Simpson Ⅱ级切除6例,SimpsonⅢ级切除2例),1例对侧下肢完全性瘫痪,7例病例术后患者对侧下肢肌力正常或短暂的力弱.随访6个月～4年2个月,失访4例,未见肿瘤复发,手术后对侧下肢力弱的病例1个月后功能恢复正常,手术后对侧下肢完全性瘫痪的1例病例6个月后肌力恢复到Ⅳ级.无死亡病例.结论显微镜下肿瘤分块切除、保护好中央静脉、处理好矢状窦、避免脑皮质损伤是提高肿瘤切除率、保护神经功能的最佳方法.
목적 탐토상시상두방렴방중1/3뇌막류적수술책략,제고종류절제솔화수술효과.방법 대5년내수술치료74례상시상두방렴방중1/3뇌막류진행료회고성연구,분석료림상、영상학화수술자료,병대환자진행료수방.결과 74례중,SimpsonⅡ급절제67례,Simpson Ⅲ급절제7례,몰유SimpsonⅠ급절제.술중소유병례시상두급중앙구정맥보호완호,피층공혈혈관미손상.종류낭내분괴절제적66례병례(Simpson Ⅱ급절제61례,Simpson Ⅲ급절제5례),술후환자대측하지기력정상혹단잠적력약.종류번전병분괴절제8례병례(Simpson Ⅱ급절제6례,SimpsonⅢ급절제2례),1례대측하지완전성탄탄,7례병례술후환자대측하지기력정상혹단잠적력약.수방6개월～4년2개월,실방4례,미견종류복발,수술후대측하지력약적병례1개월후공능회복정상,수술후대측하지완전성탄탄적1례병례6개월후기력회복도Ⅳ급.무사망병례.결론 현미경하종류분괴절제、보호호중앙정맥、처리호시상두、피면뇌피질손상시제고종류절제솔、보호신경공능적최가방법.
Objective To discuss the surgical strategy of parasagittal and falcial meningiomas in the middle 1/3 cortex area and raise resective rates of tumors and surgical effects.Methods The clinical,imaging and operative data of 74 cases of parasagittal and falcial meningiomas in the middle cortex area which underwent operation were reviewed and followed up.Results Of 74 tunors,67 were resected with Simpson Ⅱ grade,7 with Simpson Ⅲ,none of them with Simpson Ⅰ.Superior sagittal sinus and the vein of central suleus and feeders of cortex were reserved well.Severe brain injury was not occurred in 66 cases with tumors debulking(Simpson Ⅱ 61 cases,Simpson Ⅲ 5 cases),the neuro-functions of patients were normal or transient slight weakness of contralateral lower extremities postoperatively.Tumors of 8 cases were "turned over" and resected by piecemeal (Simpson Ⅱ 6 cases,Simpson Ⅲ 2 cases),weakness and paralysis of contralateral lower extremities occurred in 7 cases and 1 cases respectively after surgery.Followed-up ranged from 6 months to 4 years and 2 months,4 cases were lost to follow-up.Neuro-function of all cases with weakness of contralateral lower extremities recovered after one month.Muscle strength of the cases with paralysis of contralateral extremity recovered to grade Ⅳ 6 months later,no recurrence and death.Conclusion The measures,including piecemeal tumor reseeted mierosugically,good protection of the vein of central sulcus,excellent management of superior sagittal sinus,and avoiding damage to functional cerebral cortex during operations,are best ways for raising the tumor resection rate and nearo-function reserved.