Department of Neurosurgery, North Shore University Hospital, Northwell Health, Manhasset, New York, USA.
Department of Neurosurgery, North Shore University Hospital, Northwell Health, Manhasset, New York, USA.
World Neurosurg. 2020 Aug;140:192. doi: 10.1016/j.wneu.2020.04.223. Epub 2020 May 8.
A 79-year-old woman presented to the emergency department following multiple falls in the previous week. Her past medical history was unremarkable except for chronic obstructive pulmonary disease. She was neurologically intact on arrival with normal laboratory data. Brain imaging revealed a right-sided sphenoid wing meningioma with considerable edema around it. Owing to her cognitive decline and recent symptoms, it was decided to proceed with surgical resection of the lesion. Considering her age and underlying disease, we planned to avoid probable complications of an aggressive resection. She underwent preoperative transarterial embolization with particles. In the supine position, a right pterional craniotomy with orbital extension was performed followed by tumor resection under microscopic magnification. One of the branches of the middle cerebral artery was engulfed by the tumor and could not be separated; therefore, the artery was cut to resect the tumor and then mobilized and reanastomosed under microscope. Doppler probe confirmed patency of the anastomosis. The patient recovered well from the surgery, experienced an uneventful hospital stay, and was discharged on postoperative day 10 after completely controlling her chronic obstructive pulmonary disease. Postoperative imaging did not show any signs of infarction, and the revascularized artery was patent on postoperative computed tomography angiography (Video 1).
一位 79 岁的女性，因前一周多次跌倒而到急诊就诊。除慢性阻塞性肺疾病外，她的既往病史无其他异常。她入院时神经状态完好，实验室数据正常。脑部影像学显示右侧蝶骨翼脑膜瘤，周围有大量水肿。鉴于她认知能力下降和近期的症状，决定对病变进行手术切除。考虑到她的年龄和基础疾病，我们计划避免积极切除可能带来的并发症。她接受了术前经动脉栓塞术（用颗粒进行栓塞）。患者取仰卧位，行眶外侧扩大翼点开颅术，然后在显微镜下进行肿瘤切除术。大脑中动脉的一个分支被肿瘤包裹，无法分离；因此，为了切除肿瘤而切断了动脉，然后在显微镜下移动并重新吻合。多普勒探头确认吻合口通畅。患者术后恢复良好，无并发症，慢性阻塞性肺疾病完全控制后于术后第 10 天出院。术后影像学未显示任何梗死迹象，术后 CT 血管造影显示再血管化的动脉通畅（视频 1）。
