ABSTRACT

Background: Surgery of parasagittal meningiomas (PSMs) is still technically challenging, for the balance between radical resection and preservation of venous circulation. In this article, we’d systemically introduce the technical nuances of a simplified strategy for radical resection of all types of PSMs. All the cases were operated by one single neurosurgeon from a single institution.

Methods: Clinical charts of patients with PSMs between 2014 and 2020were retrospectively reviewed. A simplified classification method was adopted, which was based on the relationship between the tumor and superior sagittal sinus (SSS). Surgery aiming at radical resection and venous flow preservation was performed. Only in case of total occlusion of SSS, we performed tumor resection without reconstruction of the venous sinus.

Results: Clinical data obtained in 55 consecutive patients (47 primary and 8 recurrent cases) were analyzed, among which 20 were with patent sinus, 27 were with partially occluded sinus and 8 were with completely occluded sinus. Forty-two (76.4%) and 13 patients (23.6%) had the same and improved functional status as compared to that of pre-operation, respectively. Four patients (7.3%) experienced transient neurological deterioration but improved to the normal level in the long-term follow-up. All patients achieved Simpson I/II radical resection. No patients suffered from post-operative recurrence in the follow-up duration of 27.05 ± 19.55 (2–91) months.

Conclusion: Radical and safe resection of all types of PSMs is achievable and not difficult if the simplified surgical strategy mentioned in the article is adopted, no matter to which extent the sinus is invaded.

摘要

背景：矢状旁脑膜瘤 (PSM) 的手术在技术上仍然具有挑战性，要在根治性切除和保留静脉循环之间取得平衡。在本文中，我们将系统地介绍所有类型 PSM 根治性切除的简化策略的技术细微差别。所有病例均由来自同一机构的一名神经外科医生操作。

方法：回顾性分析 2014 年至 2020 年间 PSM 患者的临床图表。采用基于肿瘤与上矢状窦（SSS）关系的简化分类方法。进行了旨在根治性切除和保留静脉血流的手术。仅在 SSS 完全闭塞的情况下，我们在没有重建静脉窦的情况下进行了肿瘤切除。

结果：对连续55例患者（47例原发病例，8例复发病例）的临床资料进行分析，其中20例为鼻窦通畅，27例为鼻窦部分闭塞，8例为鼻窦完全闭塞。与术前相比，分别有 42 名（76.4%）和 13 名（23.6%）患者的功能状态相同和有所改善。4 名患者 (7.3%) 出现短暂的神经功能恶化，但在长期随访中改善至正常水平。所有患者均实现了 Simpson I/II 根治性切除。在 27.05 ± 19.55 (2-91) 个月的随访期间，没有患者出现术后复发。

结论：无论鼻窦受侵到何种程度，采用本文所述的简化手术策略，均可实现对所有类型PSMs的根治性、安全性切除，且难度不大。