3DSlicer software assisted microsurgery for parafalcine meningioma through contralateral longitudinal fissure approach / 中国综合临床

Objective:To evaluate the effect of microsurgery for parafalcine meningioma through contralateral longitudinal fissure approach assisted by 3DSlicer software.Methods:From January 2020 to January 2021, 18 patients with parafalcine meningioma in The second hospital of Hebei Medical University were randomly selected as the observation group.The contralateral longitudinal fissure was treated by microsurgery assisted by 3DSlicer software.Before operation, improve the imaging examinations such as brain CT plain and enhancement, magnetic resonance angiography and magnetic resonance venography, establish the models of tumor, superior sagittal sinus and superior cerebral artery by using 3DSlicer software, analyze the positional relationship between tumor and superior sagittal sinus and superior cerebral vein, and remove the tumor by contralateral longitudinal fissure approach.Nineteen patients with parafalx meningioma treated by traditional ipsilateral longitudinal fissure approach from January to December 2019 were selected as the control group.The differences in operation time, intraoperative bleeding, limb muscle strength recovery rate, headache and dizziness relief rate were compared between the two groups.Results:In the observation group, the positional relationship between the reconstructed tumor and the superior cerebral vein above its base was completely consistent with the actual situation during the operation.All patients underwent Simpson grade I resection, and there was no injury to the superior cerebral vein and venous sinus during the operation.The recovery rate of limb muscle strength in the observation group (75%(9/12)) was higher than that in the control group (23%(3/13))( P=0.009). There was no significant difference in the operation time, intraoperative bleeding and the remission rate of headache and dizziness one week after operation in the observation group ( P>0.05). Conclusion:3DSlicer software was helpful for preoperative evaluation of the positional relationship between parafalcine meningioma and the anatomic structures such as superior cerebral vein and superior sagittal sinus.Under the guiding of 3DSlicer software, surgeon removed the tumor totally through the contralateral longitudinal fissure approach, which effectively reduced the operative side injury of the important structures such as superior cerebral vein and functional cerebral cortex, and contributed highly to the recovery of limb muscle strength of patients.

Falcine Sinus and Parafalcine Collateral Veins in Meningiomas Invading the Superior Sagittal Sinus.

BACKGROUND: Venous collaterals form because of occlusion of the superior sagittal sinus (SSS), thus preserving venous drainage. Previous studies have focused on the evaluation and protection of sinuses and cortical veins and have neglected the collaterals between the SSS and deep venous system, which are important for surgical planning. We aimed to study the venous compensatory patterns inside and on both sides of the cerebral falx (parafalx) in patients with meningioma invading the SSS. METHODS: Conventional magnetic resonance imaging, magnetic resonance venography, and a three-dimensional reconstructed venous model of 45 patients were analyzed. The venous collateral pattern of the parafalx was divided into 4 types: A), with cerebral medial cortical vein displacement or hyperplasia; B), collaterals connect the 2 ends of the occluded segment of the SSS; C), collaterals connect the occluded segment of the SSS with the deep cerebral venous system; and D), recanalization or secondary formation of a falcine sinus. The incidence of each type in different occlusion grades and positions of the SSS was analyzed. RESULTS: The 4 types of venous collaterals were ranked according to their prevalence: A, 46.7%; C, 15.6%; D, 8.9%; and B, 4.4%. The collaterals of types B, C, and D were found only in patients with severe SSS occlusion, and both types C and D were found only in middle and posterior occlusions of the SSS. CONCLUSIONS: In meningiomas invading the SSS, especially with complete posterior SSS occlusion, the parafalcine collateral veins and falcine sinus should be evaluated preoperatively to avoid iatrogenic injury.

Microsurgical treatment of sagittal sinus, falx meningioma experience (report of 30 cases) / 中国基层医药

Objective To investigate the effects of surgical method on the falx paraneoplastic parasagittal meningiomas.Methods 30 cases of surgical treatment in sagittal sinus and falx meningioma patients with imaging data,surgical approach,microsurgical resection of the tumor method and efficacy were analyzed.Results 30 patients resected by Simpson standard,Ⅰ grade resection 23 cases,Ⅱ grade resection in 7 cases,no operative mortality.1-5 years of follow-up,2 patients relapsed,all secondary surgical cure.Conclusion To be familiar with microscopic neuroanatomical relationship,using microsurgical resection of the superior sagittal sinus,falx meningioma,tumor removal rate can be increased to reduce the important functional areas of damage,reduce complications and improve quality of life of patients.

Microsurgical treatment of meningioma in the cerebral falx and sagittal sinus / 中国基层医药

Objective To review the clinical efficacy and surgical methods of microsugical treatment for the meningioma in the cerebral falx and sagittal sinus .Methods The clinical date and microsurgery techniques of 8 pa-tients with meningioma in the cerebral falx and sagittal sinus treated by microsurgery were analyzed retrospectively . Results 7 tumors were totally removed ,including Simpson grade Ⅰin 5 cases and Simpson Ⅱin 2 cases and 1 ca-ses subtotally resection.The follow-up from 6 months to 4 years,the tumor recurred in.Conclusion The total tumor resection by microsurgery ,and effective treatment of cerebral falx and sagittal sinus in operation ,and protection of im-portant brain eloquent veins are important reasons for influence outcomes .

Cerebral falx mature teratoma with rare imaging in an adult.

Intracranial mature teratoma is a rare lesion in adults. Despite several intracranial mature teratomas had been reported not to be located at the midline region, no one was found to be within cerebral falx. Herein, we reported a 37-year-old female patient with an intracranial mature teratoma confined within frontal cerebral falx. Her main complaint was intermitted headache, which could not be relieved recently by taking painkiller. Excepting for mild papilledema, we did not find positive neurological signs on physical examination. CT scanning showed it was a round homogenously hypodense lesion with hyperdense signal at its rim. MRI revealed the lesion was 3.5 cm×3.6 cm×4.5 cm in volume, with uniformed hypointensity on T1WI, hyperintensity on T2WI and enhancement in the capsule. It was totally removed via inter-hemispheric approach, and we found the lesion was confined within the frontal cerebral falx. Postoperatively, it was proved histologically to be a mature teratoma. At three years of fellow up, neither neurological deficits nor recurrent sings on MRI was found. To our best knowledge, this is the first case of intracranial mature teratoma within cerebral falx.

Microsurgtcal treatment of large meningiomas in the sagittal sinus and faLx cerebri / 中华神经医学杂志

Objective To probe into the pre-operative design and the operative approach dealing with anastomotic vein and superior sagittal sinus in patients with large meningiomas in the sagittal sinus and falx cerebri. Methods Thirty-five patients with large meningiomas in the sagittal sinus and falx cerebri, admitted to our hospital from January 2001 to December 2010, were chosen; their clinical data were analyzed retrospectively. The resection of the tumors by microsurgery (total or subtotal resection) was performed and intraoperative effective management of the sagittal sinus and falx cerebri was done. Results Resection was performed in these 35 patients, including Simpson grade Ⅰ in 21(60.0％), grade Ⅱ in 12 (34.2％), and grade Ⅲ in 2 (5.7％). Skull defect was noted in 5 patients. Unilateral　paralysis of limbs (muscle strength grade Ⅰ-Ⅳ) in 5; paralysis of both lower extremities (muscle strength grade Ⅰ-Ⅱ) in 1; good results were achieved after 1-6 months of hyperbaric oxygen, acupuncture and physiotherapy. During the follow-up period for 6 to 24 months, the tumor recurred in 2 with Simpson Ⅲstage resection (5.7％). Conclusion Designing a detailed pre-operative design according to the MRI,MRA, DSA and CTA, application of microsurgical techniques, avoidance of damage to the cerebral cortex and veins of central suleus and protection of the sagittal sinus are important factors that increase the success rate of surgical resection, reduce complications, prevent the tumor recurrence and improve the survival outcome in patients with parasagittal meningiomas.