The Discussion About Diagnosis And Treatment Strategy Of Medial Sphenoid Ridge Meningioma

Objective:Through the clinical analysis of the clinical manifestations,diagnostic ideas,therapeutic method and prognosis about the medial sphenoid ridge meningioma,summarize a number of the skills and experiences we have gained in the process of clinical diagnosis and treatment,to optimize the preoperative,intraoperative and postoperative treatment measures to achieve maximum resection of the tumor,and reduce the damage to the peritumoral tissue.Methods:Retrospectively analysed the clinical record of 38 patients with medial sphenoid ridge meningioma,those who have been treated with microsurgery in our department from January 2013 to December 2017.Before the operation,keep an account of the patients' cardinal clinical manifestation,course time,development process,past medical history and so on.Comprehensive assess the general condition of the patient.Improve and perfect the preoperative preparation during the perioperative period.Before operation,CT,MR and MR enhanced scan were performed to evaluate the size and location of tumor,and the position nexus with the ambien nerves,vessels,cavernous sinus,brain tissue.MRA,CTA,and DSA tests are used to assess the blood supply of tumors and the relationship between tumor and peripheral blood vessels in some patients.By summarizing the auxiliary examination results,select the appropriate surgical approach.Perform carefully during the operation.Excise the tumor to the greatest extent and protect the important intracranial tissue.After the operation,observe the patient closely and take the proper disposal,record the process of the surgical operation,tumor size,texture and its relationship with surrounding tissue,tumor resection degree,etc.Summarize the operation skills duly.Review CT after operation,sifting and removing the cerebral infarction and intracranial hemorrhage,and evaluating tumor resection degree.Assess patients' preoperative symptoms improved or notbefore leaving the hospital.Results : The selection of surgical methods for 38 cases of clinical cases was pterional approach or modified pterional approach,the postoperative pathological results were all confirmed as meningioma.The resection degree of meningioma was graded by Simpson classification.Among them,31 cases run up to Simpson I grade excision.In the remaining 7 patients,meningiomas had different degrees of adhesion with these tissues,including the internal carotid artery,hypothalamus,optic nerve,abducens nerve,cavernous sinus and the middle cerebral artery.During the tumor resection,in order to avoid injurying to the above tissue,which may bring about complications,we performed Simpson grade IV resection to the above 7 patients during the operation.And recommend radiation therapy after operation.Before surgery,among the 38 cases in our study,19 cases manifested as headache,dizziness,9 cases showed blurred vision or decreased visual acuity(including 1 case of blindness),1 case of exophthalmos,1 case showed ptosis,1 cases showed memory loss,1 case epilepsy,2 cases showed that the movement of limbs was not as good as normal,1 case with syncope,3 cases of meningioma found in physical examination.In addition to 1 cases of blindness before operation,no relief after operation,and 1 cases of postoperative cerebral infarction,the remaining 33 cases had different degrees of relief and improvement after operation.3 cases who found meningioma in the physical examination before surgery did not have any new symptoms after the operation.And no1 patients died.Conclusion : The comprehensive preoperative general condition assessment and accessory examination,the correct operative approaches,the meticulous and careful micromechanical operation and proper preoperative postprocessing,can play a significant effect in improving the surgical resection rate,reducing the complications and improving the patient's recovery during the time of diagnosing and treating of the medial sphenoid ridge meningioma.