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  [摘要] 目的 探讨矢状窦旁脑膜瘤的显微手术方法及临床疗效。 方法 回顾性分析采用显微手术治疗的40例矢状窦旁脑膜瘤患者的临床资料。 结果 本组无手术死亡病例，术后DSA或MRI检查显示上矢状窦显影良好，血流通畅。术后均获随访，随访时间6个月～3年，其中35例恢复正常工作或学习，疗效满意，5例遗留有不同程度的肢体功能障碍。 结论 充分的术前综合性评估，选择适当的手术入路，有效控制术中出血，可提高肿瘤全切除率，减少矢状窦、中央沟静脉和重要脑功能区的损伤，减少并发症，提高患者术后的生存率和生存质量。

 [关键词] 脑膜瘤；上矢状窦；显微外科；并发症；生存率

 [中图分类号] R739.45 [文献标识码] B [文章编号] 1673-7210(2012)02(c)-0152-02

 Clinical analysis of 40 cases for microsurgery in sagittal sinus meningioma

 LIU Shaobo WANG Fan ZHANG Peng XIONG Zhiwei WANG Zhiyong

 Department of Neurosurgery, Hu′nan Provincial Hospital of Brain Diseases, Hu′nan Province, Changsha 410000, China

 [Abstract] Objective To investigate the clinical effects and methods of microsurgery in sagittal sinus meningioma. Methods The clinical data of 40 cases for microsurgery in sagittal sinus meningioma were analyzed retrospectively. Results There was no dead case after operation, the scanning of DSA or MRI also showed well at the superior sagittal sinus with a good blood circulation. 40 cases had a follow-up for half year to 3 years, there were 35 cases recovered well and could return to work or study among the 40 cases with successful and satisfied treatments. The other 5 cases got varying degrees of limbs disturbance. Conclusion Sufficient comprehensive preoperative evaluation, proper operative approach, efficient control of hemorrhage, all of these can increase the total resection rate of meningioma, decrease the lesion of longitudinal sinuses, central sulcus vein and important brain active area, reduce the complication and enhance patients surviver rate after operation.

 [Key words] Meningioma; Sagittal sinus; Microsurgery; Complication; Survival rate

 矢状窦旁脑膜瘤(PSM)是指肿瘤基底附着于上矢状窦并充满矢状窦角的脑膜瘤。由于其邻近矢状窦、中央沟静脉及大脑皮层功能区等重要结构，往往给手术治疗带来一定困难[1]。2008年1月～2011年6月，我院共收治矢状窦旁脑膜瘤患者40例，均采用显微外科手术方法切除并获得了满意的效果，现将结果报道如下：

 1 资料与方法

 1.1 一般资料

 本组共40例，其中男16例，女性24例；年龄17～62岁，平均49岁；病程3个月～4年，平均19个月；表现为头痛、呕吐、 视乳头水肿等颅内压增高症状者30例，癫痫发作9例，精神障碍10例，偏瘫等定位体征者19例，无明显症状者3例(体检时发现)。所有患者均经头部CT、MRI检查确诊为上矢状窦旁脑膜瘤。肿瘤位于矢状窦前1/3者11例，中1/3者23例，后1/3者6例；肿瘤直径3～9 cm，其中≥3 cm且7 cm且≤9 cm者9例。

 1.2 方法

 在气管插管全麻下手术，矢状窦前、中1/3肿瘤患者取仰卧位，后1/3者取俯卧位。根据影像学检查结果设计皮瓣及骨瓣，手术入路采用冠状切口(前1/3)或马蹄形切口(中、后1/3) ......