Maiuri Francesco, Donzelli Renato, Pagano Serena, Mariniello Giuseppe
Department of Neurosciences and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, "Federico II" University School of Medicine, Naples, Italy.
Department of Neurosciences and Reproductive and Odontostomatological Sciences, Neurosurgical Clinic, "Federico II" University School of Medicine, Naples, Italy.
World Neurosurg. 2019 May;125:357-363. doi: 10.1016/j.wneu.2019.02.032. Epub 2019 Feb 22.
To define, from a series of surgically treated meningiomas of the posterior fossa with dural attachment above the dural sinuses, the best management of the sinus invasion according to the pattern of venous circulation.
Seventy-five patients with posterior fossa meningioma whose dural attachment involved the major venous sinuses were included in the study. We considered tumor location and dural attachment, pattern of venous sinus circulation, degree of sinus involvement and its management, entity of surgical resection, complications, and recurrences.
The resection of the involved sinus segment (Simpson I) was performed in 15 patients (20%) (10 with complete occlusion and pattern of circulation of types A and B and 5 with narrowed sinus and type B circulation); 42 cases (56%, all of type 1) were treated by coagulation and/or removal of the outer dural layer (Simpson II). In 14 (19%) the intrasinusal fragment was left (Simpson III), and in 4 (5%) the resection was partial, with residual intradural tumor (Simpson IV). No postoperative complications secondary to venous obstruction occurred. Eleven patients (15%) experienced tumor recurrence and were reoperated on. Only 4 of them with extensive dural invasion had further recurrence.
In patients with posterior fossa meningiomas, we suggest to safety resect the involved sinus segment only when completely occluded. If the sinus lumen is not invaded or the tumor lies on the side of the unique or dominant transverse sinus, it should be preserved. This results in no or negligible risk of venous infarction and rather low recurrence rate.
从一系列经手术治疗的后颅窝硬脑膜附着于硬脑膜窦上方的脑膜瘤中，根据静脉循环模式确定窦侵犯的最佳处理方法。
本研究纳入75例硬脑膜附着累及主要静脉窦的后颅窝脑膜瘤患者。我们考虑了肿瘤位置和硬脑膜附着情况、静脉窦循环模式、窦受累程度及其处理方法、手术切除范围、并发症和复发情况。
15例患者（20%）（10例完全闭塞且静脉循环模式为A和B型，5例窦腔狭窄且为B型循环）切除了受累的窦段（辛普森一级）；42例（56%，均为1型）采用凝固和/或切除硬脑膜外层进行治疗（辛普森二级）。14例（19%）保留了窦内肿瘤碎片（辛普森三级），4例（5%）为部分切除，有硬膜内残留肿瘤（辛普森四级）。未发生继发于静脉阻塞的术后并发症。11例患者（15%）出现肿瘤复发并接受再次手术。其中只有4例硬脑膜广泛侵犯的患者再次复发。
对于后颅窝脑膜瘤患者，我们建议仅在窦完全闭塞时安全切除受累的窦段。如果窦腔未受侵犯或肿瘤位于单一或优势横窦一侧，则应予以保留。这样可使静脉梗死风险为零或可忽略不计，且复发率相当低。
