The Assessment Of The Preoperation Angiography Of Dural Sinus Meningiomas In Neurosurgical Treatment Guidance (56cases Report)

Meningioma invaded dural venous sinus is always invaded sinus wall andsinus cavity，and encroaches easily sinus wall and the sinus cavity, which notonly changes normal anatomy, but also can invade and surrounding skull andthe venous system. Blind operation can result in temporary or permanentparalysis, increased intracranial pressure and even death and other seriousconsequences. Through the assessment of angiography of meningioma，and thedegree of the sinus involvement，and the establishment of collateral circulation.That can provide important information for neurosurgery. We retrospectivelyanalyzed56cases. They supplied from neurosurgery department inChina-Japan union Hospital of Ji Lin University from January,2003, to January,2011.We mainly focuses on tumor and venous sinus relationship characteristics,and establishment of collateral circulation, and microsurgical operation.Allpatients underwent CT and/or MRI examination. Including47cases of MRVexamination,9cases had underwent DSA examination. In the MRVexamination group, there are four manifestations:(1) Showed meningiomaassociated with venous sinus, but sinus without changes,15cases, including thesuperior sagittal sinus10cases, transverse sinus3cases, sigmoid sinus2cases;(2) Showed mild compression of venous sinus, but sinus patency,19cases,including the superior sagittal sinus12cases,4transverse sinus cases,3sigmoid sinus cases;(3) The meningiomas invaded venous sinus, sinus uneventhickness, but the sinus not completely occluded6cases, including thesuperior sagittal sinus in4cases,2torcular Herophili-transverse sinus cases;(4) Venous sinus completely occlusion, and visible compensatory collateralcirculation formation in7patients, including5superior sagittal sinus,transverse sinus in2cases. In the DSA examination group in9patients, there are two main forms:(1) Tumor invaded venous sinus, sinus uneven thickness,but not completely occluded in7cases, including4superior sagittal sinus,transverse sinus and sigmoid sinus3cases;(2)Venous sinus completelyocclusion, and compensatory collateral circulation formation in2patients,including2cases of superior sagittal sinus.According to Simpson resection of meningioma grading standard,56cases of resection grade Ⅰ in19cases (34%), grade II in27patients (48%),grade III resection in6cases (11%), IV in4cases (7%), no grade Ⅴ excisionand operation death case. All cases were treated by microneurosurgery. Thereare3cases have transient Limb dysfunction in, transient blurred vision in3cases, permanent Limb dysfunction in3cases. In the operation procedure,based on the preoperative radiographic assessment, in the MRV cases group,meningioma with sinus have relations, but no change in patients with venoussinus, and venous sinus sinus mild compression, sinus patency case, there areno obvious discrepancy in intraoperation procedure. The mengningiomasinvaded venous sinus, sinus uneven thickness, the sinus cavity narrowing butnot completely occluded case, intraoperation visualisation confirmed completeanastomosis; Venous sinus completely occluation one case has confirmedpreopreation, and compensatory collateral circulation formation cases, but byclamping the superior sagittal sinus venous congestion was observed in15min-30min, there was obviously Venous congestive edema in intraoperativeprocedure,indicated the sinus was incomplete occlusion. In DSA cases group,preoperative angiography data and operation procedure was no obviouslydiscrepancy.41patients received follow-up, form2months to7years. Simpsongrade I performed during the follow-up showed no tumor recurrence,1caseswas recurrence in Simpson grade II recection, Simpson III resection infollow-up period including2cases recurrence, Simpson IV resection follow-upperiod there were2cases of recurrence. Through this group of cases we have concluded thefollowingconclusions:(1)preoperative intracranial venous sinus meningiomasimaging date have important magnificence. It can clearly indicated tumor site,shape, size and the presence of calcification and skull changes, for operationapproaches provide important information; at the same time it can fullyunderstand the meningioma associated with venous sinus relationships, theanatomic variation, as well as the importance of venous drainage establishment,but should be paid attention to preoperative imaging data of false positive.(2)In entire operation procedure, should pay attention to control hemorrhage.Excision of separation shall be under operation microscope, strict operation,and protect the normal anatomic structure. To make sure not to aggravate thepreexisting neurological damage, as far as possible to strive for total tumorremovation. For the preoperative radiographic assessment of venous sinusocclusion, intraoperative venous sinus occlusion still confirmed, so as toeliminate false positives. For not cut all the tumor at all, postoperative can usemodern radiosurgery techniques, some Auxiliary means may be safely andeffectively treated.