Microsurgical Strategy For Parafalcine Meningioma

Background:Parafalcine meningioma originate from the falx,they are completely covered by the cortex,which are generally located in the longitudinal fissure.They may growth through the falx and are often bilateral.They grow slowly,early symptoms are not obvious,when the tumor volume is larger,increased intracranial pressure or neurological localization symptoms were found,and active surgical treatment is the most important way to reduce tumor recurrence.Tumor location is deep,intraoperative exposure is relatively difficult,if not properly handled,often causing paralysis of the contralateral lower limbs,postoperative epilepsy and other serious complications.Gross total resection parafalcine meningioma under the premise of safety is challenging.The purpose of this paper is to explore the method and effect of microsurgical treatment of parafalcine meningioma.Methods:The data of 22 cases of parafalcine meningioma treated by the same surgeon in our hospital were retrospectively analyzed.Based on magnetic resonance imaging sagittal images,the tumor was divided into 3 parts according to the girth and coronal sutures.At the same time,based on the coronal contrast enhanced magnetic resonance imaging(MRI)of the tumor were divided into three categories,all patients were treated by interhemispheric dissection to access the parafalcine tumor.Results: Twenty-two patients underwent preoperative lumbar cistern drainage.No cauda equina injury,no hematoma,no cerebrospinal fluid leakage,no spinal canal infection and no herniation after operation.None of the patients in this group increased the surgical exposure by resecting the medial cortices of the brain.Eight patients underwent intraoperative brachial pressure gently on the medial side of the brain for a short period of time.Fourteen patients underwent intraoperative combined with gravity,exposing the tumor with aspirator and bipolar coagulation.According to SimpsonGrading: 13 cases were grade ?,6 Grade? and 5 Grade ?.No massive bleeding during the operation,no intraoperative blood transfusion in patients.During operation,18 patients with intact arachnoid space were found in preoperative MRI.The arachnoid space was clear and complete during operation.The other 4 patients showed incomplete arachnoid space on MRI,and 2 patients found arachnoid The gap is complete,2 cases of arachnoid space is not clear.Meningiomas are divided into three groups according to the cell type,cell mitosis,cell characteristics,necrosis and invasiveness.Postoperative pathological examination prompted WHO grade ? meningioma in 20 cases,WHO grade ? meningioma in 2 cases,no WHO grade ? meningioma patients.No significant cerebral contusion and operative hematoma were found in all the 22 cases after CT examination.One case of postoperative CT was found to have edema.The muscle strength of new lower extremities was decreased after operation,and the muscle strength returned to normal after one month.One case of headache symptoms did not relieve postoperatively,one case of post-operative hemiplegia in patients with muscle strength improved,but still unable to take care of themselves,postoperative epilepsy,oral valproate sodium epilepsy control of symptoms.Other patients with headache and dizziness and other symptoms were alleviated,hemiplegia symptoms disappear.No infection after surgery.No recurrence during follow-up.No deaths after surgery.Conclusion: Parafalcine meningiomas can be diagnosed by imaging examination?The main treatment of parafalcine meningioma is microsurgery.Adequate preoperative examination,classification of tumors,a detailed understanding the relationship between the tumou and peripheral blood vessels,functional areas,is very important for making a surgical plan.Conventional lumbar drainage,natural retraction of brain tissue after drainage of cerebrospinal fluid,combined with the use of brain tissue gravity,can reduce the stretch of the brain tissue and a good exposure to the tumor.Under direct vision intraoperative,the fine operation,pay attention to the protection of the drainage bridge vein and the corpus callosum,the renal artery to minimize the vascular and cortical damage caused by surgery.To ensure the quality of life of patients,to maximize tumor resection to reduce tumor recurrence rate.Postoperative patient management isalso very important,Postoperative attention to patient follow-up,review,for patients who failed to do a complete resection of the tumor,it is recommended as soon as possible after gamma knife treatment.