Matsuda Masahide
Department of Neurosurgery, Institute of Medicine, University of Tsukuba.
No Shinkei Geka. 2024 Jul;52(4):726-735. doi: 10.11477/mf.1436204972.
During surgery for meningioma, basic surgical techniques and strategies required for the removal of the tumor are common, particularly for tumors located superficially, such as convexity, parasagittal, and falx meningiomas. Four basic surgical techniques, including detachment; devascularization; debulking; and dissection should be combined and repeated in appropriate sequence, tailored to the specific conditions of each tumor. This eventually enables the total circumferential dissection of the tumor from the surrounding tissues. It is essential to retract the tumor towards the space created at the tumor center through internal debulking, rather than retracting the normal brain, to avoid damage to the surrounding brain tissue. During surgery for parasagittal meningioma with venous sinus occlusion, it is crucial to preserve the cortical veins that have developed as collateral pathways to prevent venous complications. During surgery for falx meningioma, the selection of a surgical approach including a contralateral approach based on factors such as the development of bridging veins and significant peritumoral brain edema is required. In this article, detailed surgical procedures for convexity meningioma, parasagittal meningioma, and falx meningioma were described focusing on the application of fundamental surgical techniques tailored to each tumor type.
在脑膜瘤手术中，切除肿瘤所需的基本手术技术和策略是常见的，特别是对于位于浅表的肿瘤，如凸面、矢状窦旁和镰旁脑膜瘤。四种基本手术技术，包括分离、去血管化、减瘤和解剖，应根据每个肿瘤的具体情况，以适当的顺序组合并重复使用。这最终能够从周围组织对肿瘤进行全周解剖。通过内部减瘤将肿瘤向肿瘤中心形成的空间牵拉，而不是牵拉正常脑组织，以避免损伤周围脑组织，这一点至关重要。在伴有静脉窦闭塞的矢状窦旁脑膜瘤手术中，保留已发育为侧支通路的皮质静脉以预防静脉并发症至关重要。在镰旁脑膜瘤手术中，需要根据桥静脉的发育和肿瘤周围明显的脑水肿等因素选择手术入路，包括对侧入路。在本文中，重点描述了针对每种肿瘤类型的基本手术技术应用，详细介绍了凸面脑膜瘤、矢状窦旁脑膜瘤和镰旁脑膜瘤的手术步骤。
