Microanatomy Peritumoral Brain Edema (PTBE) And Blood Vessel Regeneration In Surgical Treatment Of Petroclival Meningiomas

Petroclival meningliomas offer the greatest technical challenge to the neurosurgons because of their critical location. This region involves any important basal nerves and blood vessles. Petroclival meningliomas often displace these adjacent structures and engulf or encase arteries and cranial nerves encountered during their growth. All these increase the opportunity of damaging neurovascule in operations. It takes neurosurgons much time to expose the anatomy of this region. Meanwhile the pressurization of tumours and blooding offer obstructions. So experting in microanatomy of petroclivus and optimal operative appoach becomes more and more important and cell proliferation and blood vessle regeneration and peritumour edema is critical in directing the excision and prognosis of tumours. Our topic study focuses in the followings: 1,observing analysing microanatomy of petroclivus in normal and pathological conditions. 2,opproaching the clinical value of magnetic resonance imaging in diagonosis and operative therapy in petroclival meningliomas. 3,opproaching optimal operative approach and technique to expose and excise tumors and protecte neurovascules and decrease complications in petroclival meningliomas. 4,opproaching the relations among the expression of VEGF ,vascular components and peritumour edema of brainstem and the clinical value of these parameters. Our topic conclusions focuses in the followings: 1,When excising the tumors by tempo-occpital approach drilling os petrosum for exposing petroapex and upper clivus needs more attention. Meantime attention should be pay to carotid canal and internal acoustic meatus. 2,The tempo-occpital approach is more advantageous than others. But lumber puncture before operation is necessary for exposing tumours. 3,In the course of operation protecting Labbe vein (especially left ) is important. Labbe veins empty into transverse sinus where there is three sorts of degree (90.45.-45degree). The best method of isolating Labbe vein is to section the arachnoid by adoping 360 degree. All these can make apex of os petrosum and clivus clear. 4,Insecting parts of temporal lobe base is helpful to expose the operative field sufficiently. 5,The whole operation is made up of three elements: lumber pucture ,isolating Labbe vein by adoping 360 degree method and insecting parts of temporal lobe base. 6,The location of the transverse sinus isn't invariant. Sometimes it may move up and the distance is 2cm about. 7,The abducent nerve originates from the nucleus nervi abducentis in bulbopontine bounderline. First there are many strings. Then they converge into beam which goes along the basement of the pons. After a 0.6-1.8 distance the abducent nerve turns right into Dorello's tube where the sheath of nerve forms including arachnoid. 8,During the operation the first step is to mutilate the meningohypophyseal trunk and the blood supply of the dura. Then removing the meningiomas should be in the tumour. When cutting the blood supply of the petroclival region the operation should be between the dura which can reduce the bleed. Reducing the voltaic strenth can decrease the damage of the brainstem. Duing the separating the basal artery encased by tumour the operation should be between the dura. The retention of perforating branch can avoid the stroke of the brainstem. 9,MRI is imperative because it can not only make diagnosis clear but also predict prognosis. The tumours which formation is globe or ellipsoid provide a feeble compression and vascular adherence than those segmented tumors. But they are hard and have not peploses. It leads to the difficulty of insecting the meningiomas . The T1-weighted and T2-weighted MRI can show clealrly the edema of the brainstem mainly throught the existence of the arachnoid or not. The brainstem edema is the result of damagment of the pia mater. So dexamethasone and mannitol is necessary before preoperation. If the tumour blood supply is affluent then...