岩上静脉和岩上窦的解剖变异及其在岩斜脑膜瘤手术中的处理策略和教训

doi:10.13418/j.issn.1001-165x.2020.05.007

中国临床解剖学杂志 ›› 2020, Vol. 38 ›› Issue (5): 528-535.doi: 10.13418/j.issn.1001-165x.2020.05.007

• 颅内静脉解剖与循环障碍 • 上一篇下一篇

岩上静脉和岩上窦的解剖变异及其在岩斜脑膜瘤手术中的处理策略和教训

黄惠勇¹，　李欢²，　杨修¹，　吴震²

1.北京中医药大学厦门医院神经外科，福建厦门 361000； 2.首都医科大学附属天坛医院神经外科，北京　100050

收稿日期:2020-01-17 出版日期:2020-09-25 发布日期:2020-10-21
通讯作者: 杨修，主任医师，E-mail：272683556@qq.com
作者简介:黄惠勇（1978-），男，福建漳州人，博士，主要研究颅底肿瘤及脑血管病的手术治疗，E-mail：hhy791129@126.com
基金资助:
福建省厦门市科技局惠民项目（3502Z20154051）

The anatomical variation of superior petrosal vein and superior petrosal sinus and its management and lesson during the surgery for petroclival meningioma

HUANG Hui-yong¹, LI Huan², YANG Xiu², WU Zhen²

1.Department of Neurosurgery, Xiamen Hospital of Beijing University of Chinese Medicine, Xiamen 361000, China; 2. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing 100050, China

Received:2020-01-17 Online:2020-09-25 Published:2020-10-21

摘要/Abstract

摘要： 目的　探讨岩上静脉（SPV）和岩上窦（SPS）的解剖变异及其在岩斜脑膜瘤手术中的处理策略和教训。方法　回顾性分析岩斜脑膜瘤手术治疗病例19例，按照岩斜脑膜瘤的分型采用不同入路方式进行手术，观察SPV和SPS的解剖变异并进行分型，处理手术并发症。结果　脑膜瘤手术全切除（Simpson Ⅰ/Ⅱ级）63.2%（12例），近全切除（Simpson Ⅲ级）36.8%（7例）。术中见SPV和SPS解剖分型Ⅰ型有63.2%（12例），Ⅱ型21.1%（4例），Ⅲ型15.8%（3例）。采用经岩前中颅窝底入路10例，10例离断SPS，2例损伤SPV；采用幕上下经岩骨乙状窦前入路4例，3例离断SPS，1例损伤SPV；采用枕下乙状窦后入路5例，1例损伤SPV。所有病例中，手术离断SPS 68.4%（13例），损伤SPV 21.1%（4例）；其中引起严重并发症15.8%（3例）。结论　岩斜脑膜瘤手术前通过影像或全脑血管造影（DSA）检查了解SPV和SPS的解剖分型，有助于手术入路的选择，避免术中不必要的损伤，减少术后并发症的发生。

关键词: 岩斜脑膜瘤, 　岩上静脉, 　岩上窦, 　解剖变异

Abstract: Objective　To investigate the anatomical variation of superior petrosal vein (SPV) and superior petrosal sinus (SPS) and its management during the surgery for petroclival meningioma.　Methods　19 cases of petroclival meningiomas from October 2017 to October 2019 were analyzed retrospectively. Different approach were used to perform the operation according to the classification of petroclival meningioma. The anatomical classification of SPV and SPS was observed and made category. The operative complications were treated.　Results　Total resection (Simpson I / II) was performed in 12 cases (accounting for 63.2%), and nearly total resection (Simpson III) in 7 cases (accounting for 36.8%). During the operation, there were 12 cases (accounting for 63.2%) of type I in the anatomical variation of SPV and SPS, 7 cases (accounting for 21.1%) of type II and 11 cases (accounting for 15.8%) of type III. There were 10 cases of transpetrosal middle cranial fossa approach, 10 cases of disconnection SPS and 2 cases of injured SPV were . 4 cases of supratentorial and infratentorial presigmoid approach were performed, including 3 cases of disconnection SPS and 1 case of injured SPV . 5 cases of retrosigmoid approach were treated, including 1 case of injured SPV. In all cases, 13 cases (accounting for 68.4%) were injured SPS, 4 cases (accounting for 21.1%) were injured SPV, and 3 cases (accounting for 15.8%) were serious complications.　Conclusions　DSA examination before the operation of petroclival meningioma to understand the anatomical variation of SPV and SPS is helpful for the choice of operative approach, avoiding the unnecessary injury and reducing the postoperative complications.

Key words: Petroclival meningioma, 　Superior petrosal vein, 　Superior petrosal sinus, 　Anatomical classification

中图分类号:

黄惠勇, 李欢, 杨修, 吴震. 岩上静脉和岩上窦的解剖变异及其在岩斜脑膜瘤手术中的处理策略和教训[J]. 中国临床解剖学杂志, 2020, 38(5): 528-535.

HUANG Hui-yong, LI Huan, YANG Xiu, WU Zhen . The anatomical variation of superior petrosal vein and superior petrosal sinus and its management and lesson during the surgery for petroclival meningioma[J]. Chinese Journal of Clinical Anatomy, 2020, 38(5): 528-535.

参考文献 11

[1]	Natarajan SK, Sekhar LN, Schessel D, et al. Petroclival meningiomas meningiomas: multimodality treatment and outcomes at longterm follow up[J]. Neurosurgery, 2007, 60(6): 965-98l.
[2]	Dandy, Walter E. An operation for the cure of tic douloureux: partial section of the sensory root at the pons[J]. Arch Surg, 1929(2), 18: 687-734.
[3]	Ken M, Toshio M, Yoshihiro K, et al. Classification of the superior petrosal veins and sinus based on drainage pattern[J]. Neurosurgery, 2014, 10(2): 357-367.
[4]	Vinayak N, Amey RS, Devi PP, et al. Safety profile of superior petrosal vein (the vein of Dandy) sacrifice in neurosurgical procedures: a systematic review[J]. Neurosurg Focus, 2018, 45 (1): E3.
[5]	A Koerbel, A Gharabaghi, S Safavi-Abbasi, et al. Venous complications following petrosal vein sectioning in surgery of petrous apex meningiomas[J]. Eur J Surg Oncol, 2009, 35(7): 773-779.
[6]	吴震, 李达, 郝淑煜, 等. 岩斜脑膜瘤分型及手术入路选择研究[J]. 中华神经外科杂志，2012, 8(28): 783-787.
[7]	R Shimada, H Kiyosue, S Tanoue, et al. Superior petrosal sinus: hemodynamic features in normal and cavernous sinus dural arteriovenous fistulas[J]. AJNR Am J Neuroradiol, 2013, 34(4): 609-615.
[8]	张文毅, 高峰, 伊志强, 等. 海绵窦区三角解剖及面积的临床应用[J]. 中国临床解剖学杂志, 2019, 37 (1): 1-4.
[9]	曾星, 黄莉珍, 姜迎, 等. 颈内动脉海绵窦段解剖及其临床应用[J]. 中国临床解剖学杂志, 2019, 37 (2): 231-233.
[10]	冯旭, 钱增辉, 汤可, 等. Kawase入路操作方向对脑干显露影响的虚拟现实解剖学研究[J]. 中国临床解剖学杂志, 2017, 35(4): 384-387.
[11]	Tanriover N, Abe H, Rhoton AL Jr, et al. Microsurgical anatomy of the superior petrosal venous complex: new classifications and implications for subtemporal transtentorial and retrosigmoid suprameatal approaches[J]. J Neurosurg, 2007, 106(6): 1041-1050.

岩上静脉和岩上窦的解剖变异及其在岩斜脑膜瘤手术中的处理策略和教训

The anatomical variation of superior petrosal vein and superior petrosal sinus and its management and lesson during the surgery for petroclival meningioma

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