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Objective:To evaluate the effect of microsurgery for parafalcine meningioma through contralateral longitudinal fissure approach assisted by 3DSlicer software.Methods:From January 2020 to January 2021, 18 patients with parafalcine meningioma in The second hospital of Hebei Medical University were randomly selected as the observation group.The contralateral longitudinal fissure was treated by microsurgery assisted by 3DSlicer software.Before operation, improve the imaging examinations such as brain CT plain and enhancement, magnetic resonance angiography and magnetic resonance venography, establish the models of tumor, superior sagittal sinus and superior cerebral artery by using 3DSlicer software, analyze the positional relationship between tumor and superior sagittal sinus and superior cerebral vein, and remove the tumor by contralateral longitudinal fissure approach.Nineteen patients with parafalx meningioma treated by traditional ipsilateral longitudinal fissure approach from January to December 2019 were selected as the control group.The differences in operation time, intraoperative bleeding, limb muscle strength recovery rate, headache and dizziness relief rate were compared between the two groups.Results:In the observation group, the positional relationship between the reconstructed tumor and the superior cerebral vein above its base was completely consistent with the actual situation during the operation.All patients underwent Simpson grade I resection, and there was no injury to the superior cerebral vein and venous sinus during the operation.The recovery rate of limb muscle strength in the observation group (75%(9/12)) was higher than that in the control group (23%(3/13))( P=0.009). There was no significant difference in the operation time, intraoperative bleeding and the remission rate of headache and dizziness one week after operation in the observation group ( P>0.05). Conclusion:3DSlicer software was helpful for preoperative evaluation of the positional relationship between parafalcine meningioma and the anatomic structures such as superior cerebral vein and superior sagittal sinus.Under the guiding of 3DSlicer software, surgeon removed the tumor totally through the contralateral longitudinal fissure approach, which effectively reduced the operative side injury of the important structures such as superior cerebral vein and functional cerebral cortex, and contributed highly to the recovery of limb muscle strength of patients.
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Objective To review the clinical efficacy and surgical methods of microsugical treatment for the meningioma in the cerebral falx and sagittal sinus .Methods The clinical date and microsurgery techniques of 8 pa-tients with meningioma in the cerebral falx and sagittal sinus treated by microsurgery were analyzed retrospectively . Results 7 tumors were totally removed ,including Simpson grade Ⅰin 5 cases and Simpson Ⅱin 2 cases and 1 ca-ses subtotally resection.The follow-up from 6 months to 4 years,the tumor recurred in.Conclusion The total tumor resection by microsurgery ,and effective treatment of cerebral falx and sagittal sinus in operation ,and protection of im-portant brain eloquent veins are important reasons for influence outcomes .
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Objective To investigate the effects of surgical method on the falx paraneoplastic parasagittal meningiomas.Methods 30 cases of surgical treatment in sagittal sinus and falx meningioma patients with imaging data,surgical approach,microsurgical resection of the tumor method and efficacy were analyzed.Results 30 patients resected by Simpson standard,Ⅰ grade resection 23 cases,Ⅱ grade resection in 7 cases,no operative mortality.1-5 years of follow-up,2 patients relapsed,all secondary surgical cure.Conclusion To be familiar with microscopic neuroanatomical relationship,using microsurgical resection of the superior sagittal sinus,falx meningioma,tumor removal rate can be increased to reduce the important functional areas of damage,reduce complications and improve quality of life of patients.
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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.