Yoshimura Kosei, Tsunoda Sho, Segawa Masafumi, Kawashima Mariko, Inoue Tomohiro, Akabane Atsuya
Department of Neurosurgery, NTT Medical Center Tokyo, Shinagawa, Japan.
Surg Neurol Int. 2024 Sep 13;15:331. doi: 10.25259/SNI_620_2024. eCollection 2024.
Meningiomas are histologically benign tumors and generally have a good prognosis. However, some are classified as high-grade meningiomas due to their strong invasion of surrounding tissues and high postoperative recurrence rates, resulting in a poor prognosis. Postoperative radiotherapy is often administered for the most malignant anaplastic meningiomas; however, its contribution to improving prognosis and reducing recurrence rates in patients with residual tumors is limited.
We present here a 48-year-old man with an anaplastic meningioma that recurred repeatedly and had invaded the right anterior cerebral artery (ACA) despite two postoperative radiotherapy sessions. Dissecting the tumor from the blood vessels was extremely difficult and would only have achieved a partial resection. However, we achieved complete resection by performing a pericallosal artery-pericallosal artery (A3-A3) side-to-side anastomosis and excising the infiltrated blood vessels along with the tumor . No neurological deficits or complications, such as cerebral infarction, were detected postoperatively.
Although reports of performing an A3-A3 side-to-side anastomosis to enable complete resection of tumors invading the ACA are extremely rare worldwide, this procedure should be recognized as a safe and effective treatment option when complete tumor resection is strongly desired, as in the present patient.
脑膜瘤在组织学上是良性肿瘤，通常预后良好。然而，一些脑膜瘤由于对周围组织的强烈侵袭和高术后复发率，被归类为高级别脑膜瘤，导致预后不良。对于最恶性的间变性脑膜瘤，术后常进行放疗；然而，其对改善残留肿瘤患者的预后和降低复发率的作用有限。
我们在此介绍一名48岁男性，患有间变性脑膜瘤，尽管进行了两次术后放疗，仍反复复发并侵犯了右侧大脑前动脉（ACA）。将肿瘤从血管中分离出来极其困难，且只能实现部分切除。然而，我们通过进行胼周动脉-胼周动脉（A3-A3）端侧吻合，并连同肿瘤一起切除浸润的血管，实现了完全切除。术后未检测到神经功能缺损或诸如脑梗死等并发症。
尽管在世界范围内，关于进行A3-A3端侧吻合以实现对侵犯ACA的肿瘤进行完全切除的报道极为罕见，但当像本病例患者一样强烈希望实现肿瘤完全切除时，该手术应被视为一种安全有效的治疗选择。
