Chen G, Zhai W W, Yu Z Q
Ward 11 of Surgery Department, the First Affiliated Hospital of Soochow University, Suzhou 215000, China.
Zhonghua Yi Xue Za Zhi. 2016 Jun 28;96(24):1926-8. doi: 10.3760/cma.j.issn.0376-2491.2016.24.012.
To investigate varying patterns of intracranial pressure(ICP)after giant meningioma resection and analyze the causes of the variation of ICP in different postoperative phases.
Clinical data, surgical approachs and the ICP monitoring data of 7 patients with giant meningioma in different positions who were admitted to the First Affiliated Hospital of Soochow University from October 2013 to July 2014 and received microsurgical resection via different approachs were analysed retrospectively. The tumour locations were in convexity(n=1), olfactory groove(n=1), sphenoidal ridge(n=2), parasagittal(n=1), falx(n=1), petroclival(n=1) and resected via longitudinal fissure approach, subfrontal approach, extensive pterional approach, subtemporal approach. ICP monitoring probe was placed subdurally and average monitoring time was 9 days. Dehydrating agent was administered in all cases postoperatively.
Tumors were totally resected (Simpson Grade Ⅰ or Ⅱ ) in all patients. The increase of ICP was observed on the 3(rd) day, peaked on the 4(th) day and reduced to normal on the 5(th)-7(th) day. Decompressive craniectomy and tracheotomy were performed in one case due to consciousness deterioration, severe brain edema and continuous ICP augment on the third day after operation. All the patients recovered well except for the cerebrospinal fluid rhinorrhea occurring in one case postoperatively, whose symptom ameliorated significantly after conservative treatment.
ICP monitoring exerts an important role on the postoperative management of giant meningioma. Simultaneously, The summary of vast ICP monitoring data concerning to giant meningioma provides the evidence and experience for protecting neurological function via abundant preoperative preparations, reasonable operative approach, careful postoperative management.
探讨巨大脑膜瘤切除术后颅内压（ICP）的变化规律，分析不同术后阶段ICP变化的原因。
回顾性分析2013年10月至2014年7月苏州大学附属第一医院收治的7例不同部位巨大脑膜瘤患者的临床资料、手术入路及ICP监测数据，这些患者接受了不同入路的显微手术切除。肿瘤位置分别为凸面（n = 1）、嗅沟（n = 1）、蝶骨嵴（n = 2）、矢状窦旁（n = 1）、大脑镰（n = 1）、岩斜区（n = 1），分别经纵裂入路、额下入路、扩大翼点入路、颞下入路进行切除。硬膜下放置ICP监测探头，平均监测时间为9天。所有病例术后均使用脱水剂。
所有患者肿瘤均全切除（辛普森分级Ⅰ级或Ⅱ级）。术后第3天观察到ICP升高，第4天达到峰值，第5 - 7天降至正常。1例患者术后第3天因意识恶化、严重脑水肿及ICP持续升高行去骨瓣减压术和气管切开术。除1例患者术后出现脑脊液鼻漏，经保守治疗后症状明显改善外，所有患者恢复良好。
ICP监测在巨大脑膜瘤术后管理中发挥重要作用。同时，大量关于巨大脑膜瘤的ICP监测数据总结为通过充分的术前准备、合理的手术入路、精心的术后管理来保护神经功能提供了依据和经验。
