皮质中央区和其附近窦旁1

《皮质中央区和其附近窦旁1》由会员上传分享，免费在线阅读，更多相关内容在行业资料-天天文库。

1、临近脑皮质中央区的矢状窦旁、镰旁脑膜瘤显微手术切除张龙阮金成孟庆勇张卫民张功义赵东宁赵庆解放军第152医院神经外科（河南平顶山467000）【摘要】目的探讨临近中央区脑皮质的矢状窦旁、镰旁脑膜瘤显微手术切除的术前评估及术中注意要点，以期获得较好的脑功能保护并最大程度减少手术并发症。方法总结分析我科2006年5月至2012年4月间显微手术切除的皮质中央区邻近区矢状窦旁、镰旁脑膜瘤42例病例的影像及临床资料。结果肿瘤全切除35/42例(SimpsonⅠ级17例，Ⅱ级18例)，次全切除7例。术后短期出现偏瘫或加重者共17例，其中出院时12例已恢复正常，5例遗

2、有偏瘫者(肌力Ⅲ级3例，肌力Ⅰ~Ⅱ级2例)现已随访2年仍留偏瘫(肌力Ⅲ级)者3例。目前保持随访1～5年的38例患者有2例复发，经予γ刀放疗至今3年未见肿瘤增大。结论术前认真分析CT、MRI及其必要的无创性血管成像资料，评判肿瘤切除中需要特别注意保护的重要结构；肿瘤的显微手术切除及窦旁皮质回流静脉的严密保护,可有效提高肿瘤全切率,减少手术并发症。【关键词】脑膜瘤、运动皮质、血管成像、显微手术；Investigationonmicrosurgeryofparasagittalandparafalxmeningiomaadjacenttomotorialco

3、rtexZhangLongRuanJin-chengMengQing-yongZhangGong-yiZhaoDong-ningZhaoQing(DepartmentofNeurosurgery,the152hospitalofPLAinPingdingshanofHenanprovince467000,China.)【Abstract】　ObjectiveToexplorethepreoperationdiagnosisandmicrosurgicaltechniquefortheparasagittalorparafalxmeningiomasad

4、jacenttomotorialcortex.MethodsThe42patientswithparasagittalorparasfalxmeningiomasadjacenttomotorialcortex,whoreceivedmicrosurgeryfromMay2006toApril2012,theirdiagnosisimagingsandclinicaldatawereanalyzedretrospectively.Results　AccordingtoSimpson’sresectionclassification,ofthe42pat

5、ients,17receivedGradeⅠand18receivedGradeⅡresection,7receivedGradeⅢresection.Ofthe42patients,17casesoccurredshort-termhemiplegiapostoperation.38casesbefollowing-upfrom1to5yearsshowedthatretainhemiplegia3patientsandthemeningiomasrecurredin2patients.Conclusion　Theparasagittalorpara

6、falxmeningiomasadjacenttomotorialcortexcanbetotallyresectedbymicrosurgicaltechniques.Thesufficientpreoperativeimagingevaluation,goodprotectionoftheveinofcentralsulcus,excellentmanagementofsuperiorsagittalsinus,andavoidingdamagetofunctionalcerebralcortex,allthesesmeasurescansigni

7、ficantlyincreasethepercentageoftotalremovalofthetumorsanddecreasepostoperativecomplications,andimprovesurvivaloutcome.【Keywords】meningioma;motorialcortex;vesselimaging;microsurgery【中图分类号】R739.45【文献编识码】A皮质中央区指上状窦中1/3临近的额顶叶躯体运动中枢的中央前回、感觉中枢的中央后回及其附近辅助脑皮质区；脑膜瘤好发于矢状窦旁和大脑镰旁，该部位脑膜瘤约占颅内

8、脑膜瘤的25%[1]，皮质中央区邻近的窦旁、镰旁脑膜瘤常生长嵌插于脑组织内，有时沿大脑镰向双侧