Mantovani Alessandra, Di Maio Salvatore, Ferreira Manuel J, Sekhar Laligam N
Department of Neurological Surgery, University of Washington, Harborview Medical Center, Seattle, Washington, USA.
Division of Neurosurgery, McGill University, Jewish General Hospital, Montreal, Quebec, Canada.
World Neurosurg. 2014 Sep-Oct;82(3-4):455-67. doi: 10.1016/j.wneu.2013.06.024. Epub 2013 Jul 10.
The optimal surgical management of meningiomas involving the major venous sinuses represents a therapeutic dilemma. The decision is whether to leave a fragment of the lesion and have a higher recurrence rate, especially for World Health Organization classification II/III tumors, or to attempt total removal and potentially increase risk to the venous circulation. We present the surgical strategies we follow in managing meningiomas involving the major venous sinuses and the potential benefit of these techniques for higher grade tumors.
Between 2005 and 2013, 38 patients underwent operations. Preoperative and postoperative data were retrospectively analyzed. The surgical strategies based on sinus invasion are discussed.
Meningiomas involved the superior sagittal sinus (26 patients), Torcular Herophili (5), transverse (5), or sigmoid sinus (2 patients). In 13 patients, the sinus was totally occluded, in 9 subtotally (50%-95%), and in 14 patients partially (<50%), whereas two tumors involved the outer layer of the sinus wall. Twenty-seven patients had World Health Organization classification grade I meningiomas and 11 grade II. A gross total resection was achieved in 86.9% of patients, and sinus reconstruction followed in 21 cases: 13 by direct suture and 8 using a patch. Postoperatively, the sinus was patent (52.4%), or narrow but patent (33.3%) in 85.7% of these patients. No deaths and one major postoperative complication occurred, and the mean postoperative KPS score was 88.9±15.3. Two recurrences (5.3%) occurred during a mean follow-up of 26.05 months.
The surgical strategies presented, achieving minimal morbidity, support the practice of aggressive removal of tumors invading the sinus, particularly in the case of higher grade meningiomas.
涉及主要静脉窦的脑膜瘤的最佳手术治疗是一个治疗难题。决策在于，是留下部分病变组织从而有更高的复发率，尤其是对于世界卫生组织分类为II/III级的肿瘤，还是尝试全切并可能增加静脉循环的风险。我们介绍了在处理涉及主要静脉窦的脑膜瘤时所采用的手术策略，以及这些技术对高级别肿瘤的潜在益处。
2005年至2013年间，38例患者接受了手术。对术前和术后数据进行回顾性分析。讨论了基于窦侵犯情况的手术策略。
脑膜瘤累及上矢状窦（26例患者）、窦汇（5例）、横窦（5例）或乙状窦（2例患者）。13例患者中静脉窦完全闭塞，9例部分闭塞（50%-95%），14例患者部分闭塞（<50%），而2例肿瘤累及静脉窦壁外层。27例患者为世界卫生组织分类I级脑膜瘤，11例为II级。86.9%的患者实现了肿瘤全切，21例患者进行了静脉窦重建：13例采用直接缝合，8例使用补片。术后，85.7%的这些患者中静脉窦通畅（52.4%）或狭窄但通畅（33.3%）。无死亡病例，术后发生1例严重并发症，术后平均KPS评分为88.9±15.3。在平均26.05个月的随访期间发生2例复发（5.3%）。
所介绍的手术策略将发病率降至最低，支持积极切除侵犯静脉窦的肿瘤的做法，尤其是在高级别脑膜瘤的情况下。
