Power Robert G, Lam Fred C, Whitton Anthony C, Sharma Sunjay, Kasper Ekkehard M
Division of Neurosurgery, DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
Department of Radiation Oncology, Juravinski Cancer Centre, Hamilton, Ontario, Canada.
J Neurol Surg Rep. 2023 Aug 25;84(3):e92-e102. doi: 10.1055/s-0043-1772201. eCollection 2023 Jul.
Meningiomas that invade the confluens sinuum are rare and require extensive preoperative planning. Here, we describe the surgical and radio-oncological management of an aggressive large occipital meningioma invading the superior sagittal sinus, torcula, right and left transverse sinus down to the level of the jugular bulb in a 21-year-old female patient. Details of the surgical approach are presented to highlight the planned staged resection of this tumor at the level of the torcula to initially debulk the lesion while preserving venous outflow through the patent's sinus. Once the tumor fully occluded the confluens, a second-stage en bloc resection ensued. Postsurgical adjuvant radiation therapy was delivered via fractionated external beam therapy which has provided local control of the tumor since. This case is being discussed in the context of the pertinent literature to demonstrate the highly complex interdisciplinary and staged management of partially intravascular meningiomas involving the major venous sinuses.
侵犯窦汇的脑膜瘤较为罕见，需要进行全面的术前规划。在此，我们描述了一名21岁女性患者侵袭性大型枕叶脑膜瘤的手术及放疗管理情况，该肿瘤侵犯上矢状窦、窦汇、左右横窦直至颈静脉球水平。本文介绍了手术入路的细节，以突出在窦汇水平对该肿瘤进行计划性分期切除，最初在保留患者窦内静脉流出道的同时使肿瘤体积缩小。一旦肿瘤完全阻塞窦汇，则进行二期整块切除。术后辅助放疗通过分次外照射进行，自那时起已实现对肿瘤的局部控制。结合相关文献讨论该病例，以展示涉及主要静脉窦的部分血管内脑膜瘤的高度复杂的多学科及分期管理。
