Microsurgical Treatment Of Parasagittal Meningioma Clinical Stuey

Objective:Parasagittal sinus meningioma (PSM) is a common intracranial benigntumor. As PSM adjacent to the origin in the arachnoid granulations, tumor growth iseasy invasion of superior sagittal sinus,also the surrounding tumor is oftenaccompanied by significant cortical vein, so, the radical resection of the meningiomaspresents several hazards.This retrospective clinical study is to explore themicroneurosurgery technology used in the resection of PSM and the effect of thetreatment.Methods: Between January2006and December2011,a series of73cases withparasagittal sinus meningiomas underwent micro-neurosurgery in the NeurosurgeryDepartment of the First Affiliated Hospital of Dalian Medical University. Aretrospective analysis is performed on the clinical data of the32cases in thisseries.There were12males,20females,with age between21~70years,mean age45.3years.Results:1.presentation of preoperative imageology examination:14cases arelocated in the left side,12cases in the right side,6cases involving bilateral,15cases inthe anterior third of the sss,11cases in the middle third,6cases in the posterior third. In13cases,tumor has close relationship with the surrounding cortical drainage.Incompleteocclusion of sss caused by tumor compression or violations were discovered in19casesand complete occlusion with good collateral circulation in3cases.2.Intraoperatively,average blood loss was450ml and important cortical veins around thetumor get good protection;According to Simpson meningiomas resection system,Gradeâ…  was achieved in18cases (56.3%), Grade â…¡ in11cases (34.4%), Grade â…£in2cases (6.3%), no resection of grade â…¢ and â…¤.3. Postoperative complications: musclestrength decline in5cases, which have been varying degrees of muscle recovery after rehabilitation treatment;new epilepsy occurred in1cases after surgery; Patients withpostoperative cerebrospinal fluid leakage does not occur; There were no perioperativedeaths.4. Followed-up ranged from1month to48months,mean23months.Among thebenign meningiomas,no patient with Gradeâ… and â…¡ resection recur,1patient withGrade â…£recur. The quality of life which measured by KPS system were improvedobviously afer surgury.Conclusions: Parasagittal meningiomas represents a difficult surgical challenge.Contemporary microsurgical techniques play an important role in the treatment ofparasagittal meningiomas. The preoperative diagnosis results obtained by CT and MRIscan are helpful in selecting the proper approach, microsurgical operation is the besttreatment to parasagittal meningiomas with less complications and high life qualities.Good understanding of the anatomy about superior sagittal sinus, application ofmicrosurgical techniques can greatly increase total resection rate of tumor, avoidpotential injury to adjacent important structures and reduce mortality. However,palliative operations should be carried out in some cases of tumors apparently invadingimportant tissues such as superior sagittal sinus and important vessels.