Kanai M, Kawano K, Uehara S
Department of Neurosurgery, Izumi Municipal Hospital.
No Shinkei Geka. 1997 Jul;25(7):641-5.
We report a case of foramen magnum meningioma in which case enhanced three-dimensional CT scan was valuable for preoperative evaluation of the surgical approach. A 53-year-old woman had suffered from stiffness and pain in the left occipital region and numbness of the left side of the face for about 2 years before admission. She had also weakness and numbness of the left side of her body for about 2 months before admission, and dysphagia and pain in the occipital region and in the posterior region of the neck produced by straining for about 1 month before admission. Neurological examination revealed left hemiparesis, and hypalgesia and tactile hypesthesia of the left side of the body, including the face. Plain X-P was normal. Enhanced CT scan and gadolinium enhanced MRI revealed a well-enhanced mass attached to the left anterolateral part of the foramen magnum. The left occipital condyle was observed at the lateral side of the attachment part of this mass. Angiography revealed tumor feeders from the meningeal branches of the left vertebral artery and the left ascending pharyngeal artery. Enhanced three-dimensional CT scan clearly showed that the tumor was attached to the left anterolateral part of the foramen magnum, that the left occipital condyle was at the lateral side of the attachment part of this mass and that the jugular foramen and jugular tubercle were situated superolateral to the attachment part of this mass. Considering these factors, we decided that removal of the posterior part of the left occipital condyle was necessary, but removal of the left jugular tubercle was not necessary for a good operative view from the left posterior lateral direction. The tumor was totally removed successfully and good results were obtained by the transcondylar approach without removal of the jugular tubercle. Histology of the tumor revealed meningothelial meningioma. In this case, preoperative evaluation with enhanced three-dimensional CT scan was helpful for deciding the surgical approach. With enhanced three-dimensional CT scan, it is easy to judge whether removal of the posterior part of the occipital condyle and/or the jugular tubercle is necessary for a good operative view, and we can get good images revealing the relationships between the tumor and surrounding structures. Preoperative evaluation with enhanced three-dimensional CT scan is very useful especially in this kind of situation.
我们报告一例枕骨大孔脑膜瘤病例，在此病例中，增强三维CT扫描对手术入路的术前评估具有重要价值。一名53岁女性在入院前约2年出现左枕部僵硬、疼痛及左侧面部麻木。入院前约2个月出现左侧身体无力及麻木，入院前约1个月因用力出现吞咽困难、枕部及颈部后方疼痛。神经系统检查发现左侧偏瘫，左侧身体包括面部痛觉减退及触觉减退。X线平片正常。增强CT扫描及钆增强MRI显示一个强化良好的肿块附着于枕骨大孔左前外侧部分。在该肿块附着部分的外侧可观察到左枕髁。血管造影显示肿瘤供血来自左椎动脉脑膜支及左咽升动脉。增强三维CT扫描清楚显示肿瘤附着于枕骨大孔左前外侧部分，左枕髁位于该肿块附着部分的外侧，颈静脉孔及颈静脉结节位于该肿块附着部分的外上方。考虑到这些因素，我们决定有必要切除左枕髁后部，但为了从左后外侧方向获得良好的手术视野，不必切除左颈静脉结节。通过经髁入路成功将肿瘤完全切除，未切除颈静脉结节也取得了良好效果。肿瘤组织学检查显示为脑膜内皮型脑膜瘤。在此病例中，增强三维CT扫描的术前评估有助于确定手术入路。通过增强三维CT扫描，很容易判断是否有必要切除枕髁后部和/或颈静脉结节以获得良好的手术视野，并且我们可以获得显示肿瘤与周围结构关系的良好图像。增强三维CT扫描的术前评估在这种情况下非常有用。
