The Vascular Protection Method And Discussion On The Microsurgery Of Medial Sphenoid Ridge Meningioma

Objective:Medial sphenoid ridge meningiomas(SRMs,sphenoid ridge meningiomas)of microsurgery of the blood vessel protection method and discussion.Methods :Collection of the xinjiang medical university first affiliated hospital of neurosurgery in September 2012 to May 2017,after the imaging diagnosis of medial sphenoid ridge meningiomas,and through the microscope surgical treatment of 64 cases of medial sphenoid ridge meningiomas of the patient’s clinical diagnosis and treatment information,for the patient’s clinical manifestations,preoperative CT,MRI,DSA,CTA,detailed imaging,preoperative integrated image data,an integrated evaluation of cerebrovascular,the choice of surgical approach and microsurgery cerebrovascular protection experience,postoperative complications occurred in the process of analysis,as well as the patients discharged from hospital after review of the follow-up data were retrospectively analyzed.Result:Group including 64 patients,male 21 cases(32.81%),female 43 cases(67.19%),the incidence of preoperative comprehensive CTA,mri,DSA,imaging data,a total of 26 cases of pushing shift on tumor blood vessels,25 cases involving tumor blood vessels were tumor packages,intraoperative all is confirmed,we will tumor resection to Simpson Ⅰ-Ⅱ resection for total removal group,Simpson Ⅲ-Ⅳ resection for partial nephrectomy.Intraoperative confirmed that 13 cases can see tumor under microsurgery with no obvious adhesion,cerebrovascular were complete resection,achieve Simpson Ⅰ-Ⅱ resection,the cutting rate of 100%;Blood vessels were pushing shift in 26 cases,including 23 cases to Simpson Ⅰ-Ⅱ resection,3 cases with tumor texture,intraoperative could not find the obvious tumor and cerebrovascular arachnoid interface,transition to avoid operation in internal carotid artery and damage blood vessels,blood vessels have a small number of residual tumor tissues to Simpson Ⅲ-Ⅳ resection,whole cutting rate was 88.5%;Intraoperative see cerebrovascular by tumor(branch),ICA,MCA and 25 cases,14 cases of tumor to Simpson Ⅰ-Ⅱ resection,11 cases of tumor to Simpson Ⅲ-Ⅳresection,the cutting rate of 56%;6 cases(9.38%)of the postoperative infection occurred,and 1 case was reexamined 6 hours after the surgery,and the hematoma was removed by the second operation.A large area of cerebral infarction occurred in the cerebral hemisphere due to cerebral vasospasm.Conclusions:Tosummarize the experience of vascular protection in the microsurgery of the medial sphenoid ridge meningioma,the following points are mainly :(1)detailed preoperative imaging examination,preoperative evaluation of the relationship between blood vessel and tumor;(2)individualized surgical approach to the development of the road,direct and remove as far as possible,to ensure that the field is clear;(3)there was no tension between the tumor and the arachnoid space between the surrounding tissues;(4)carefully separate the blood vessels passing through the tumor,separating the whole process,and carefully separating.