Clinical Characteristics And Surgical Treatment Of Intracranial Cystic

Objectiv:To analyze the clinical features of intracranial cystic meningioma,including epidemiology,clinical symptoms,imaging features and classification,surgical methods,postoperative pathology,postoperative complications,and follow-up results,to improve cystic meningioma The degree of understanding provides a reference for later clinical diagnosis and treatment of cystic meningioma.Methods : We collected 17 cases of cystic meningioma surgically treated at the Department of Neurosurgery at Anhui Provincial Hospital from July 2010 to March2016 and analyzed their clinical manifestations,imaging features,and surgical outcomes.Results:1.Among the 17 patients,there were 5 males and 17 females,aged 31-70 years old,with an average age of 51 years.Among them,the main clinical symptoms were headache,fatigue,epilepsy and other focal symptoms.There were 8 cases of headache and 3 cases of limb weakness.There were 2 cases of headache with limb weakness,2cases of epilepsy,1 case of sudden aphasia,and 1 case of binocular vision loss;5 cases of convex brain,8 cases of para-cerebral/parasinus sinus,2 cases of sphenoid ridge,and saddle tubercle 1 For example,there is one case of communication in the right hand.2.Imaging findings:In the parenchymal portion of the tumor,15 cases of CT were of equal density,1 case of slightly high density,and 1 case of high density.On T1 WI,the signal was evenly or slightly lower,T2 WI was equal or slightly higher signal,and 1 case of hemangiomas showed empty blood vessels.Of the 17 patients,16 were significantly enhanced,and 1 was slightly hyperintense.On diffusion weighted images(DWI)of allcases,the tumor was essentially iso-or slightly hyperintense;calcification was found in 1case;CT was low in all cases of cystic tumors.The signal of cystic fluid was homogeneous in 17 cases,low signal on T1 WI,and high signal on T2 WI.In 7 cases,the extracapsular cystic wall was not enhanced;in 8 cases,the typical meningeal tail sign was enhanced at the junction of the tumor and dura mater;in all cases of diffusion-weighted images(DWI),the tumor cyst was of equal signal or hypointensity.3.All the patients underwent surgical resection.According to the Zee classification,there were 10 cases of Zee I type,8 cases of simpson I grade resection,and2 cases of simpson II grade resection.There were 1 case of atypical pathology,1 case of microcapsule and 2 cases of epithelial type.There were 2 cases of fiber type,4 cases of transitional cell type,2 cases of Zee II type,1 case of complete resection of the cystic wall to achieve simpson grade I resection,and 1 case of resection of the cyst wall to reach simpson II grade resection.Pathology suggested 1 case of hemangioma and epithelium.One case had cell type,5 cases had ZeeIII type,4 cases had simpson I grade resection,and 1 case of tumor invaded the antrum and performed simpson III resection.The pathology suggested that there were 4 cases of epithelial cell tumor type and 1 case of mixed type.Follow-up from 6 months to 7 years,with an average of 4.2years.According to the GOS prognostic score,1 was mildly disabled and 1 was severely resectable.The tumors were located in the central area;1 case of giant cystic meningioma of the sphenoid ridge was discharged due to postoperative bleeding.After 1month of death;I recovered well,no tumor recurrence and death.Conclusion:1.Cystic meningiomas are relatively rare and their onset age and sex are the same as those of meningiomas.The site of its onset is also a common site of meningioma,and its clinical symptoms are related to the site of its onset.2.The imaging of cystic meningioma varies with the degree of cystic degeneration,and its performance is quite different.The degree of cystic degeneration issmaller and the cystic space is smaller.Imaging features may include general meningiomas,such as basement,meningeal tail sign,etc.,which are more easily diagnosed;cystic degeneration is higher,and the cystic space is larger.The basement of the tumor and the meningeal tail sign are not obvious and it is difficult to diagnose.3.Cystic meningioma may have different types based on the location of the cyst cavity and the imaging appearance of the cyst wall.Zee classification can better distinguish the cystic degeneration characteristics of cystic meningiomas,which is helpful to guide the formulation of surgical plans.4.The preferred treatment for cystic meningioma is surgical treatment.The ability of the tumor to completely cut depends on the location of the tumor and the extent of invasion of the surrounding tissue.For Zee I type cystic meningioma,the principle of resection is the same as general meningioma;in addition to the solid part of the tumor,Zee type II cystic meningioma needs to remove the tumor wall;Zee III type cystic meningioma can only remove the solid part of the tumor.Satisfactory tumor resection and good prognosis.