Otani Naoki, Wada Kojiro, Toyooka Terushige, Mori Kentaro
Department of Neurosurgery, National Defense Medical College, Tokorozawa, Saitama, Japan.
Asian J Neurosurg. 2018 Jul-Sep;13(3):789-791. doi: 10.4103/ajns.AJNS_158_16.
Obtaining adequate working space is difficult for complete and safe resection of meningioma located in the middle third of the falx, because of the risk of damage to the bridging veins that flow into the superior sagittal sinus and the location near the eloquent area. Consequently, surgical resection of the meningioma in the middle third of the falx tends to result in neurological disorders caused by retraction of the brain and injury of the bridging vein. Two patients underwent tumor removal of the falx meningiomas located in the middle third of the falx through the occipital interhemispheric approach (OIA) in the lateral semiprone position with the affected side down. Tumor resection was achieved safely and less invasively. Both patients suffered numbness and motor weakness, but these neurological dysfunctions improved and clinical courses were uneventful. Postoperative computed tomography showed neither brain swelling nor contusion in both cases. The OIA can remove tumor in the middle third of the falx, because the approach avoids the bridging veins, and provides working space without excessive mechanical cerebral retraction.
由于存在损伤流入上矢状窦的桥静脉的风险以及靠近功能区，对于位于大脑镰中三分之一的脑膜瘤进行完整且安全的切除时，获得足够的操作空间很困难。因此，大脑镰中三分之一处脑膜瘤的手术切除往往会导致因脑牵拉和桥静脉损伤引起的神经功能障碍。两名患者通过患侧向下的侧半俯卧位经枕叶半球间入路（OIA）切除了位于大脑镰中三分之一处的镰旁脑膜瘤。肿瘤切除安全且创伤较小。两名患者均出现麻木和运动无力，但这些神经功能障碍均有所改善，临床过程平稳。术后计算机断层扫描显示两例均无脑肿胀或挫伤。OIA可以切除大脑镰中三分之一处的肿瘤，因为该入路避开了桥静脉，并且无需过度机械牵拉大脑即可提供操作空间。
