MRV Guides To Make The Choice Of Strategies For Parasagittal Meningioma Surgery

Objective Parasagittal meningioma accounts for a considerable proportion of theintracranial meningiomas. It has high difficulty of operation, high recurrence rate,postoperative complications and mortality. It is a much more difficult clinical problem toneurosurgeon. In this study, we explore the preoperative assessment value for superiorsagittal sinus provided by3D-CE MRV, and the treatment strategies after the assessmentguidance.Methods this article retrospectively analysis the complete clinical information of45patients with sagittal sinus meningioma of Union Hospital affiliated Tong ji MedicalCollege of Huazhong Science&Technology University between September2010andMarch. It includes18males and27females and the maximum age72years, the minimumage32years old, with a median age of42years old. Preoperative magnetic resonance scanand enhancement and MRV were performed in all patients, some of which are performedby preoperative DSA. All of the patients were received microsurgical operations.Result During these patients, the number that the tumor is located in the superior sagittalsinus1/3part is14, located in the middle1/322cases, and the posterior1/3part9cases.That tumor and sinus are close but superior sagittal sinus is completely smooth are16cases,and that surgery or DSA support the diagnosis are15cases with the coincidence rate93.7%;that the sinus was pushed and violated by tumor compression and became local stenosis are20cases, and that surgery or DSA support the diagnosis are18cases with the coincidence rate90.0%. That the sinus was complete occlusion with the compensatory collateralcirculation informed are9cases, and that surgery or DSA support the diagnosis are9caseswith the coincidence rate100%. During the9cases of compensatory circulationcoincidence established completely,4cases established by Troland veins and Labbe vein,and2cases established anastomosis with deep intracranial venous, and3cases byextracranial venous system through the skin and diploe vein. According to the classificationcriteria of Simpson meningioma resection: Ⅰlevel resection14cases; Ⅱlevel resection25cases；Ⅲ level resection0case；Ⅳ level resection6cases；Ⅴ level resection0case. Thecomplications after operation: cerebral edema or cerebral edema deteriorated appeared in27cases. Hemiplegia appeared in15cases in a short time, and2cases of limb musclestrength after discharge has not been restored;9patients had low sodium and otherelectrolyte imbalance.2patients had postoperative new-onset focal seizures;1case appearspostoperative subcutaneous effusion;1patient has intracranial infection.Result Parasagittal meningioma is an common intracranial meningiomas, with thecharatertics of high incidence、high operation difficulty、high complications and highmorbidity and Mortality.3D-CE MRV able to clearly display the relationship be-tweenparasagittal meningioma and sagittal sinus. It has high specificity and sensitivity todetermine the patency of the superior sagittal sinus, also it can clearly show theestablishment of compensatory pathways around after occlusion, it has high assessmentvalue to parasagittal meningioma. microsurgery is the best way to treat sinus meningiomas.It was necessary to grasp the best timing of surgery, and make the surgical strategy, It wascritical that properly dealing with the superior sagittal sinus and protecting the drainingveins surrounding the sinus during the operation. Dealing with the involvement of the duraand the skull was the important thing to reduce the recurrence.