The Effect Of Surgicaloperation On The Meningioma Around Cerebral Centralarea

Objective: Meningiomas,mostly from the arachnoid cells,are the derivatives of meninges and meningeal gap,which accounting 19.2%-30% of primary tumor after glioma cells.Meningiomas are benign,slow growing,and its early clinical symptoms are not obvious,what is more,due to brain atrophy,low probability of early detection and easy to grow to giant meningioma,the incidence rate of meningiomas of the elderly is high.Because the central gyrus huge meningioma is located at an important functional area,peripheral vessels are rich and is beside venous sinus,the operation difficulty increases: ensuring the function of movement,sensation and language,fullcut of the tumor as far as possible and protecting the adjacent vessel or sinus are demanded for the surgeon.This paper reviews the diagnosis and treatment of giant meningiomas of central gyrus region to explore the disease preoperative preparation,surgical strategy,prognosis and complications,in order to guide the clinical treatment.Methods: 27 cases of central gyrus huge meningiomas between January 2011 and January 2016 are in the study.Before operation,all patients underwent CT + MRI(scan + enhancement + MRA + MRV)to clear the size of the tumor and edema,mass effect and feeding arteries and draining veins.Digital subtraction angiography(DSA)was also underwent in 13 patients whose blood supply to the tumor are rich.All patients underwent microsurgical treatment under general anesthesia.Assess the neurological function of the patients after 7days.Based on the CT / MRI imaging findings,the improvement of clinical symptoms,duration of the disease and surgical resection to analyse the efficacy of surgery.Results:1.the extent of resection: Simpson classification: Simpson I stage : 19 cases(70.4%),Simpson II stage:6 cases(22.3%),Simpson III stage :2 cases(7.4%)of the27 cases,no death occurred in the operation.2 Simpson III stage patients do no further processing to the involved blood vessels and sinus sites because of close ties with the central sulcus vein,the sagittal sinus and other structures.2.postoperative complications: chief complaints of headache and dizziness of 11 cases disappeared after the operation.9 cases of limb movement disorder,1developed contralateral limb movement disorder and recovered to nomal after active rehabilitation.The remaining 8 patients were restored to normal.4 cases of epilepsy symptoms disappeared in 3 patients,and no recurrence during follow-up,1 patient episodes decreased significantly than the preoperative,took oral medications and have a good effect.The 1 new case of epilepsy,took oral drugs for 2 years and no further seizures.3 cases with limb aggravated sensory disorders were cured.3 cases of small amount of meningioma cavity hematoma,about 4 ~ 10 ml,took no special treatment.8 to 15 days after surgery,they underwent CT examination and it showed the tumor cavity hematoma gradually disappeared,and adverse neurological symptoms did not appear.3.the postoperative follow-up: The 27 patients accepted followed up from 5months to 5 years,with an average follow-up time of 36 months.During the followup,all patients showed no recurrence of benign meningiomas.Conclusions:(1)Head CT and MRI can be used to clear the basic situation of the meningioma including location,size and shape,providing guidance to physicians for the development of personalized surgical plan.(2)preoperative MRV helps clearly diagnosis of superior sagittal sinus,draining vein patency and collateral circulation.DSA technique helps to know the artery as well as its relationship with meningioma for the surgical guidance.(3)During the surgery,microsurgical techniques can effectively prevent intraoperative bleeding,the greatest degree of protection of brain tissue and venous drainage,significantly reduce the incidence of complications and improve the quality of life of patients.Intraoperative cortical areas mapping wake accurately determine the extent of surgery and protection of normal brain tissue to the maximum.(4)the effective integration of microscopy and postoperative ?-knife treatment,correct assessment and proper handling of the involved superior sagittal sinus,help to reduce the recurrence of cancer and improve the therapeutic effect.