Preoperative MRV Combined With Intraoperative Ulthrasound To Evaluate Surgical Treatment Of Parasagittal Meningioma

Purpose:Explore the effect of preoperative MRV combined with intraoperativeultrasound assessment of the parasagittal sinus meningioma operation forthe treatment of clinical application.Material and Method:21patients in our hospital from2009January to2012March whowere doubted intracranial tumor by Magnetic resonance imaging wereinvolved in the study. They are all through microscope neurosurgicaloperation to resect the tumor.Combined application of preoperative MRVand intraoperative ultrasound In9patients with parasagittal sinusmeningiomas, observed the degree of the tumors pressure, invasivenessor occlusion the superior sagittal sinus, perform microsurgical operationtreatment. Compared with the results of only by preoperative MRV andmicrosurgical operation treatment.Result:Intraoperative ultrasound shows superior sagittal sinus morphology,internal structure, position feeding artery, evaluation of venous drainage,the degree of the tumors pressure, invasiveness or occlusion the superiorsagittal sinus. Postoperative scanning has no residual, evaluate theeffectiveness of the repair or reconstruction of the superior sagittal sinusetc.In4cases of MRV images have varying degrees of underestimationof compensatory venous volume and compensation amount.In1patients with tumors located in the posterior1/3part of superiorsagittal sinus, preoperative MRV tumor invasive sinus cavity, along theleft sagittal sinus wall growth, sinus cavity narrowing but unobstructed.Intraoperative ultrasound suggests that plate layer fiber cable structure exists in posterior segment of superior sagittal sinus. Sinus cavity isdivided into different sizes of the two cavities, the left has beencompletely blocked, the right unobstructed, and the tumor only invadedthe left shunt cavity. Perform the tumor and the left lateral wall resection,treat the sagittal sinus accordingly. Postoperative follow-up has a goodrecovery.In1cases with tumors located at the the midel1/3part of superiorsagittal sinus, preoperative MRV prompts the sinus cavity completeobstruction, the tumour periphery and internal exist small amount of finecompensatory vein; intraoperative ultrasound confirmed the tumorformation of abnormal venous network. MRV showed sagittal sinus wascompletely blocked, but intraoperative ultrasound suggests that there isblood. We hypothesized that the tumor itself may become an importantpart of the sinus venous reflux afte superior sagittal sinus obstructed.Complete resection may lead to severe complications. PerformIncomplete resection to relieve symptoms.Postoperative follow-up andtwo period of treatment when necessary.Conclusion:The preoperative MRV examination can generally grasp parasagittalmeningeal characteristics, peritumoral relations, thus contribute to makeoperation approach and play an important role.Intraoperative ultrasound evaluation makes up the disadvantages ofMRV that it overestimates the occlusion rate of superior sagittal sinus,and underestimate of compensatory venous volume and compensationamount, has the low specificity.Intraoperative ultrasound suggests position feeding artery, evaluatsvenous drainage, the degree of the tumors pressure, invasiveness orocclusion the superior sagittal sinus，contributes to help neurosurgeonsmake an accurate judgment，protect peritumoral venous and tissue, perform rational treatment to the involved superior sagittal sinus.Improve microscopic operation accuracy, thereby reducing theintraoperative risk, improve the resection rate, reduce the postoperativecomplications.