| Objective1.To investigate the anatomic changes of intracranial venous in diameter andnumber induced on Parasagittal meningiomas by Virtual reality,and to speculate theconstruct the compensatory pathways of parasagittal meningiomas,and guideline fordecreasing recurrence rate, morbidity rate and mortality rate and strategy for betterveins protection on parasagittal meningiomas.2. To evaluate the benefit of3D-ceMRV and VR technology in treatingParasagittal meningiomas,and to summarize our experience with the resection ofparasagittal meningiomas invading the SSS.Material and MethodsThe study selected48patients with parasagittal meningiomas and20patientswith trigeminal neuralgia or hemifacial spasm without intracranial venous systemlesions from October2012to March2014. We collect3D CE-MRV sequence from allthe patients. The scan data were imported to Dextroscope imaging workstation torebuild the anatomic structures. Collateral circulation grade, tumor location, andvarying degrees of invasion are also evaluated in the case. We further measure thediameter and number of Intracranial venous in3D perspective,including cortical vein,SSV, VT, VL, GCV, ISS, StS, TS and SS. Additionally, we follow48cases underwentsurgery and the clinical data of the them were analyzed.Results1. Tumor distribution by location along the SSS is: anterior in7, middle in31,andposterior in10. Tumor distribution by invasion is: grade1-2in24, grade3-4in12,and grade5-6in12.Collateral circulation was performed in these48cases,includinggrade0in23, grade1in9,and grade3in16.2. The average number and diameter of veins are comparable in the PSM andcontrol groups,and that the diameter of posterior SSS differs significantly for bothgroups(p <0.05), respectively,(2.07±0.84)mm and(2.64±0.97)mm. The averagenumber and diameter of other veins do not differ significantly for both groups(P>0.05). 3. The PSM is divided into3groups by the location,including anterior,middle,and posterior.The average number and diameter of veins are comparable in the anterior andcontrol groups, The average number and diameter of veins do not differ significantlyfor both groups(P>0.05).The average number and diameter of veins are comparable in the middle andcontrol groups, and that the diameter of posterior and VL differ significantly for bothgroups(P <0.05), respectively,(2.11±0.79)mm[control groups (2.64±0.97)mm],2.16±0.35mm[control groups (2.41±0.35)mm]. The average number and diameter ofother veins do not differ significantly for both groups(P>0.05).The average number and diameter of veins is comparable in the posterior andcontrol groups,.That the number of posterior and the diameter of TS differssignificantly for both groups(P <0.05), respectively,(1.60±0.70)[control groups(2.80±1.58)],(4.54±1.26)mm[control groups(5.70±0.90)mm]. The average numberand diameter of other veins do not differ significantly for both groups(P>0.05).The average number and diameter of veins is comparable in the differencelocation,and that the diameter of posterior and VL differ significantly between middleand posterior(P＜0.05), respectively,(2.59±1.30)and(1.60±0.70).4. The PSM is divided into3groups by the invasion,including grade1-2, grade3-4,and grade5-6.The average number and diameter of veins are comparable in the grade1-2andcontrol groups, The average number and diameter of veins do not differ significantlyfor both groups(P>0.05).The average number and diameter of veins are comparable in the grade3-4andcontrol groups, and that the number of anterior differs significantly for both groups(p<0.05), respectively,(3.00±1.41)[control groups(4.60±1.70)]. The average numberand diameter of other veins do not differ significantly for both groups(P>0.05).The average number and diameter of veins are comparable in the grade5-6andcontrol groups,.That the diameter of posterior and TS differ significantly for bothgroups(P <0.05), respectively,(1.53±1.14)mm[control groups(2.64±0.97)mm],(4.16±1.10)mm[control groups(5.70±0.90)mm]. The average number and diameter ofother veins do not differ significantly for both groups(P>0.05).The average number and diameter of veins are comparable in the difference invasion,and that the diameter and number of veins dose not differ significantly(P＞0.05).5. The PSM is divided into3groups by the collateral circulation,including grade0, grade1,and grade3.The average number and diameter of veins are comparable in the grade0andcontrol groups, The average number and diameter of veins do not differ significantlyfor both groups(P>0.05).The average number and diameter of veins are comparable in the grade1andcontrol groups, and that the diameter of VL and TS differs significantly for bothgroups(P <0.05), respectively,(2.06±0.21)mm[control groups(2.41±0.35)mm],(4.71±1.19)mm[control groups(5.70±0.90)mm]. The average number and diameter ofother veins do not differ significantly for both groups(P>0.05).The average number and diameter of veins are comparable in the grade3andcontrol groups.That the diameter of TS and SSV differs significantly for bothgroups(P <0.05), respectively,(4.42±1.08)mm[control groups(5.70±0.90)mm],(2.83±0.58)mm[control groups(2.32±0.45)mm]. The average number and diameter ofother veins do not differ significantly for both groups(P>0.05).The average number and diameter of veins are comparable in the differenceinvasion,and that the diameter and number of veins dose not differ significantly(P＞0.05).6.We identified48patients with parasagittal meningiomas who underwentresection,and4cases lost following. The median length of follow-up was19months(range2–46months).We included44cases with parasagittal meningiomas, including17males and27females, aged27to85years old, Simpson grade I/II in41(93.18%), collateral circulation grade3in16(36.36%), the new post-operativeneurological dysfunction or original symptoms worsen in9,the long-term neurologicadysfunction in6(13.64%),postoperative venous sinus thrombosis in3(6.82%),onepatient died (2.27%). tumor recurrence was noted in1patients (2.27%).7. Tumor resection with SSS which involving the superior sagittal sinus wasnoted in9patients,and the percent of poor prognosis(mRS≤2) was33.33%. Tumorresection with pursue SSS Grafting was noted in3cases,and the percent of poorprognosis(mRS≤2) was also33.33%. Tumor resection with SSS electrocoagulationwas noted in32patients,and2patients had poor prognosis(6.25%). Compared with the3types of dealing with SSS involved by Fisher exact test,and that the rate does notdiffer significantly(P＞0.05). Poor prognosis factors analyzed on3differenttreatment methods showed no significant difference (P＞0.05).Conclusion1. PSM change the diameter and number of the posterior BrV.when the tumor islocated in posterior, it has a profound effect on BrV location posterior SSS.2. PSM could cause the diameter of VL and bridging veins minished, decreasethe number of bridging veins and increasing the diameter of the SSV.3.The experiment implies that PSM which invaded of SSS can reduce thedrainage of VL, TS,bridge veins and increase drainage of SSV, then importingcavernous sinus and eventually drained skull.4.It contributes to select the type of the surgery,to improve the prognosis byevaluating collateral circulation and invasion,investigating the on PSM patients.5.The VR technology and3D CE-MRV help surgeon get more anatomicinformation about meningioma and its state of venous circulation,choose theappropriate surgical procedures,reducing venous injuried,lead to better prognosis. |
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