Microsurgtcal treatment of large meningiomas in the sagittal sinus and faLx cerebri / 中华神经医学杂志

Objective To probe into the pre-operative design and the operative approach dealing with anastomotic vein and superior sagittal sinus in patients with large meningiomas in the sagittal sinus and falx cerebri. Methods Thirty-five patients with large meningiomas in the sagittal sinus and falx cerebri, admitted to our hospital from January 2001 to December 2010, were chosen; their clinical data were analyzed retrospectively. The resection of the tumors by microsurgery (total or subtotal resection) was performed and intraoperative effective management of the sagittal sinus and falx cerebri was done. Results Resection was performed in these 35 patients, including Simpson grade Ⅰ in 21(60.0％), grade Ⅱ in 12 (34.2％), and grade Ⅲ in 2 (5.7％). Skull defect was noted in 5 patients. Unilateral　paralysis of limbs (muscle strength grade Ⅰ-Ⅳ) in 5; paralysis of both lower extremities (muscle strength grade Ⅰ-Ⅱ) in 1; good results were achieved after 1-6 months of hyperbaric oxygen, acupuncture and physiotherapy. During the follow-up period for 6 to 24 months, the tumor recurred in 2 with Simpson Ⅲstage resection (5.7％). Conclusion Designing a detailed pre-operative design according to the MRI,MRA, DSA and CTA, application of microsurgical techniques, avoidance of damage to the cerebral cortex and veins of central suleus and protection of the sagittal sinus are important factors that increase the success rate of surgical resection, reduce complications, prevent the tumor recurrence and improve the survival outcome in patients with parasagittal meningiomas.

Treatment of symptomatic epilepsy by lesionectomy combined with cortex thermocoagulation under the monitoring of cortical EEG / 中华神经医学杂志

Objective To observe the clinical effects of lesionectomy combined with bipolar coagulation on the cortexes with epileptogenic foci in symptomatic epilepsy. Methods Twenty-three cases of space-occupying lesion complicated by secondary epilepsy were treated by lesionectomy combined with bipolar coagulation under cortical EEG monitoring, and the control rate of epilepsy after operation was studied during the follow-up. Results All cases were followed up for 20 months on average. The clinical success of the treatment was assessed according to the criteria of the International Epilepsy Institute:level Ⅰ 14 cases,levelⅡ5 cases,levelⅢ2 cases,levelⅣ2 cases.The success rates (level Ⅰ,ⅡandⅢ)amounted to 91.3%(21/23). Conclusions Lesionectomy combined with cortex thermocoagulation is safe and effective in the treatment of symptomatic epilepsy.