Kotapka M J, Kalia K K, Martinez A J, Sekhar L N
Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pennsylvania.
J Neurosurg. 1994 Aug;81(2):252-5. doi: 10.3171/jns.1994.81.2.0252.
Intracranial meningiomas are known to infiltrate surrounding structures such as the calvaria and dural sinuses, and the brain itself. The issue of whether meningiomas invade major intracranial arteries is of clinical importance, particularly in the case of meningiomas of the cavernous sinus. If a meningioma has not invaded the carotid artery wall, complete tumor removal may be accomplished with careful dissection from the carotid artery; however, if the tumor has infiltrated the wall of the carotid artery, complete removal may require sacrifice of the artery. To determine whether cavernous sinus meningiomas invade the carotid artery, the authors retrospectively reviewed the histopathology of 19 consecutively treated individuals whose carotid artery was sacrificed during removal of a meningioma involving the cavernous sinus. Patients were selected for carotid artery resection based on preoperative magnetic resonance imaging studies demonstrating complete encasement of the artery. Reconstruction of the carotid artery was planned depending on the results of preoperative balloon test occlusion with blood flow determinations. None of the 19 patients had pathological evidence of malignant tumor. Eight individuals (42%) were found to have infiltration of the carotid artery by meningioma. In five cases, focal involvement of the adventitia of the carotid artery wall was noted and, in three, the vessel was infiltrated up to the tunica muscularis. In no case was the tunica muscularis invaded by tumor. Thus, meningiomas of the cavernous sinus do infiltrate the internal carotid artery and, in order to completely resect these lesions and effect a surgical cure, it may be necessary to sacrifice the carotid artery with or without reconstruction.
颅内脑膜瘤已知会浸润周围结构，如颅骨和硬脑膜窦以及脑本身。脑膜瘤是否侵犯颅内主要动脉这一问题具有临床重要性，尤其是在海绵窦脑膜瘤的情况下。如果脑膜瘤未侵犯颈动脉壁，通过小心地从颈动脉进行剥离或许可完整切除肿瘤；然而，如果肿瘤已浸润颈动脉壁，则可能需要牺牲该动脉才能完整切除。为了确定海绵窦脑膜瘤是否侵犯颈动脉，作者回顾性分析了19例在切除累及海绵窦的脑膜瘤过程中牺牲了颈动脉的连续治疗患者的组织病理学情况。根据术前磁共振成像研究显示动脉完全被包绕而选择进行颈动脉切除的患者。根据术前球囊试验闭塞及血流测定结果计划颈动脉重建。这19例患者均无恶性肿瘤的病理证据。8例（42%）被发现有脑膜瘤浸润颈动脉。5例中，可见颈动脉壁外膜有局灶性受累，3例中血管浸润达肌层。无一例肿瘤侵犯肌层。因此，海绵窦脑膜瘤确实会浸润颈内动脉，为了完整切除这些病变并实现手术治愈，可能有必要牺牲颈动脉，无论是否进行重建。
