Transsagittal and falx meningioma resection

There are a few sagittal sinus meningiomas and para-cerebral meningioma that grow on either side of the sagittal sinus or cerebral palsy. The tumor tissue can span the superior sagittal sinus, envelop the sinus, and partially or completely occlude the sinus cavity. These tumors have a wide base and involve the sagittal sinus or both sides of the cerebral palsy. The blood supply to the tumor is very abundant, mainly from the middle dura mater artery. The scalp artery is also involved in the blood supply to the tumor. It can also be seen that the anterior cerebral artery and the middle cerebral artery branch into the tumor. On the surface of the tumor, a large vein is seen and merges into the adjacent superior cerebral vein, and then flows back to the superior sagittal sinus. Curing disease: Indication Once diagnosed as a trans-sagittal sinus or a trans-cerebral meningioma, surgical treatment should be performed in principle. Contraindications Once diagnosed as a trans-sagittal sinus or a trans-cerebral meningioma, surgical treatment should be performed in principle. Preoperative preparation 1. See Preoperative Preparation for Neurosurgery. 2. See "resection of the parasagittal meningioma" and "resection of the cerebral palsy meningioma". 3. Focus on the size, extent and blood supply of the tumor on both sides of the sagittal sinus or cerebral palsy and whether the sagittal sinus is occluded and occluded. Surgical procedure (1) Scalp incision: Since the tumor is bilateral, a conventional one-sided horseshoe-shaped incision cannot be used. An S-shaped incision can be used, and the anterior tumor is a coronary incision, a transverse incision, and a horseshoe-shaped incision. It is also possible to use an oblique "S" shaped incision and a mid-line horseshoe-shaped incision on one side of the base. Because the scalp is very rich in blood, you must pay attention to stop bleeding when you cut the opening skin. (2) Skull treatment: This type of meningioma often invades the dura mater, skull and extracranial tissue. Skull hyperplasia is prominent, the cranial top is bulging outward, and there are often endogenous epiphyses, which are difficult to distinguish from tumors. In addition, the tumor blood supply is very rich, so the bone flap cannot be inverted according to conventional methods. Appropriate treatment methods can be selected according to the patency of the sagittal sinus as understood by preoperative angiography. When the sagittal sinus of the lesion is completely occluded, and the method of removing the affected skull, dura mater and tumor is prepared, multiple bone holes can be made around the periphery of the tumor shown by the skull mass or CT. The forceps are bitten to form a wide groove of bone. In the process of drilling and biting, the bone wax should be used to fill the venous hemorrhage in time. If there is dural vascular hemorrhage, it should be electrocoagulated or sutured. Another method is: when the tumor is still confined to the dura mater, mainly protruding to the cerebral hemisphere on both sides, one side of the bone flap can still be used for craniotomy. Use a rongeur to bite the bone in the midline and the opposite side of the area that needs to be exposed. (3) Treatment of the dura mater: After the formation of the bone groove, the exposed dural arteries are electrocoagulated or sutured one by one through the bone groove to reduce bleeding. If the bone flap has been turned over or the bone is removed, the dura mater is completely exposed, and it can be electrocoagulated around the tumor to sew all blood supply vessels. Sometimes the tumor can invade the dura mater extensively. At this time, the dura mater can be cut from the outer edge of the tumor to the edge of the sagittal sinus. (4) Resection of the tumor: After forming the skull bone groove along the circumference of the tumor and cutting the dura mater from both sides, the skull and dura mater of the tumor area have been loosened, and the "island" of the skull and the tumor may protrude outward. Separate. The specific operation is the same as "cerebral convex meningioma resection". After the tumor is detached from the cerebral hemisphere, the superior sagittal sinus is treated. The upper sagittal sinus can be temporarily clamped at the anterior and posterior end of the tumor for 15 minutes. For example, there is no congestion in the veins on the surface of the brain, indicating that the collateral circulation has been established, and the segmental sinus resection is feasible. A Doppler detector can also be used to detect complete occlusion of the superior sagittal sinus. When the superior sagittal sinus is removed, the superior sagittal sinus is double-slited at the front end of the tumor with a round needle thick thread, then cut at the proximal tumor, the tumor is pulled upward, and the tumor is cut at least 0.5 cm away from the tumor in the longitudinal fissure of the brain. The cerebral palsy and attention to control the sagittal sinus hemorrhage. After the cerebral palsy was removed, the tumor was turned backwards, the tumor surface was further released, the artery entering the tumor was clipped and cut, and the superior sagittal sinus was sutured and cut at the posterior end of the tumor as described above, and the tumor was completely removed. If the preoperative examination and the intraoperative clamping test indicate that the sagittal sinus is not completely obstructed, the surgical procedure should be selected according to the position of the tumor before and after. If the tumor invades the first 1/3 of the sagittal sinus, the tumor can still be treated with the entire sagittal sinus segment as described above. If the tumor invades the middle and the third of the sagittal sinus, the superior sagittal sinus should be preserved. The tumors on both sides can be removed or staging according to the method of sagittal sinus meningioma resection. (5) Closing the cranial cavity: After the tumor is resected, the residual cavity should be completely hemostasis, and the temporalis fascia or aponeurotic aponeurosis should be used to repair the dural defect. The skull defect was repaired or delayed according to the patient's condition at that time. If the tumors on both sides of the sagittal sinus are resected, it is difficult to achieve full resection, and the possibility of tumor recurrence is large. In this case, only the dura mater can be repaired, and the skull defect is not repaired. Stitch the aponeurosis and skin. The surgical residual cavity was placed in a silicone tube for drainage. complication (1) severe brain swelling: more common in the central vein of the surgical injury or a few thicker bridge veins; or because the superior sagittal sinus is not occluded or occluded, the collateral circulation is not well established, the upper sagittal sinus is improperly removed , venous return disorder occurs, causing severe or difficult to control brain swelling. Therefore, it is necessary to prevent the damage of the large bridge vein and the different segmentation and occlusion according to the superior sagittal sinus, and choose an appropriate treatment method. (2) Brain dysfunction: It is caused by damage to certain structures on the inner side of the brain. For example, mental symptoms may appear on the inner side of the injured frontal lobe, and both lower extremity paralysis may occur on the side of the central region of the injury. The inner side of the injured occipital lobe may have visual field defects or even blindness in both eyes. Therefore, special attention should be paid to the protection of adjacent brain tissue when separating tumors.

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