Cerebral convexity meningioma
Introduction
Introduction to brain convex meningioma Cervical meningioma refers to meningiomas on the lateral side of the cerebral hemisphere, including the cerebral hemisphere frontal, apical, occipital, meningiomas and lateral fissure meningiomas of the lobes, and normal brain tissue between the tumor and the sagittal sinus. . Clinical manifestations may only be manifested as epileptic symptoms and are easily overlooked. basic knowledge The proportion of illness: 0.03% Susceptible people: no specific people Mode of infection: non-infectious Complications: cerebral edema meningitis
Cause
Brain convex meningioma etiology
Outward growth (25%):
Meningioma mainly invades the skull to grow outward, and the periosteum is also affected, while the compression and adhesion to the surface of the cerebral hemisphere is mild.
Inward growth (30%):
Meningioma mainly grows into the cranial cavity, and the tumor is closely adhered to the meninges. The blood supply is mainly from the dura mater. The cerebral cortex is depressed and forms a deep tumor fossa. The tumor is closely adhering to the tumor fossa. Arterial supply is also available from the brain parenchyma. The corresponding part of the skull has irritative hyperplasia (endogenous osteophytes).
Brain parenchyma (30%):
Meningioma grows into the brain parenchyma, the roots on the dura mater are small, and the tumor nodules in the brain are larger. Blood supply is mainly from the brain. In this type of meningioma surgery, remember not to damage the brain tissue too much.
Prevention
Convex meningiomas prevention
Maintaining a good emotional state and proper physical exercise can optimize the body's immune system and is equally beneficial for preventing meningioma and preventing other diseases.
Complication
Cerebral convex meningioma complications Complications cerebral edema meningitis
If surgery is performed, the following complications may occur:
1. Cerebral edema is caused by intraoperative operation or venous damage. It should be carefully operated during operation, postoperative dehydration, and intracranial pressure reduction. Some patients have large cerebral edema before surgery. Dehydration treatment is required.
2. The cause of postoperative intracerebral hematoma may be incomplete hemostasis during surgery, or it may be spontaneous rupture of the artery. Stop bleeding before closing the skull, increase chest pressure, check the tumor groove and place a suitable drainage tube to prevent the concurrency. Symptoms, sudden headache, vomiting, physical activity disorder, CT should be reviewed in time after coma, if more postoperative bleeding, patients with obvious symptoms of compression or blood loss, should immediately remove the hematoma to prevent cerebral palsy.
3. Limb hemiplegia, hemianopia, aphasia and other dysfunctions are mostly caused by intraoperative injury functional area. Careful operation during surgery is the key. After the occurrence of neurotrophic drugs can be improved, a small number of patients with blood flow due to compression of brain tissue A transient loss of function can occur due to excessive perfusion, edema, and the like.
4. Meningitis meningitis occurs more than 1 week after surgery, patients continue to have high fever, neck resistance, cerebrospinal fluid leukocytosis, neutrophil ratio increased, but cerebrospinal fluid bacterial culture can be negative to prevent meningitis It is the key, so try to shorten the operation time, reduce the tumor residual, preventive application of antibiotics after surgery, and preventive lumbar puncture after removal of the drainage tube is the key. Once the diagnosis of meningitis is diagnosed, the antibiotic should be applied in the early stage. Puncture and drainage of cerebrospinal fluid can also be used for drainage of lumbar puncture and, if necessary, intrathecal injection of antibiotics.
5. Others such as patients with dysfunction of heart, liver, lung, kidney, etc. before surgery, organ failure may occur after surgery.
Symptom
Cerebral convex meningioma symptoms Common symptoms Sensory disturbance Increased intracranial pressure Intracranial hypertension Intermittent headache Slow growth Nausea hemianopia
The history of brain convex meningioma is generally longer, depending on the location of the tumor, mainly including the following aspects:
1. The symptoms of increased intracranial pressure are seen in 80% of patients. Because of the slow growth of tumors, the symptoms of intracranial hypertension usually appear later. If the tumor is located in the "non-functional area" of the brain, such as the frontal pole, the patient may only have intermittentness for a long time. Headaches and headaches are mostly located in the forehead and ankles, which are progressively aggravated, followed by nausea, vomiting and optic disc edema, and secondary optic atrophy.
2. Contusion in the parietal lobe and central sulcus of the convex meningioma can cause localized epilepsy, or from localized to epileptic seizures, seizures occur mostly in the early and middle stages of the disease, with epilepsy as the first symptom many.
3. Exercise and sensory disturbances are more common in the middle and late stages of the disease. As the tumor continues to grow, the patient often has numbness and weakness in the contralateral limbs. The upper limbs are often heavier than the lower limbs, and the central facial paralysis is more obvious. The convex meningioma of the temporal lobe may appear above. The limb-based central iliac crest, the tumor located in the dominant hemisphere still has motor and sensory aphasia, and the tumor in the occipital lobe may have the same hemianopia.
4. The bony mass of the head is easy to invade the skull due to the superficial location of the tumor. The patient's head often has a bony mass and is accompanied by scalp vasodilation.
Examine
Examination of convex meningioma of the brain
1. EEG examination was one of the auxiliary diagnostic methods for convex meningioma. It has been replaced by CT in recent years. The current role of EEG is to evaluate the epilepsy of patients before and after surgery, and to apply anti-epileptic drugs. Efficacy assessment.
2. Cerebral angiography can understand the blood supply of the tumor, the source of the blood supply artery [intracranial and/or external carotid artery], whether the middle cerebral artery is displaced by the tumor and whether the drainage vein leads to the lateral fissure vein, etc. The characteristic shift of the local blood supply to the frontotemporal and central region can be seen. The vascular expression of the tumor in the occipital region is not obvious. The vertebral artery angiography can show the thickening of the posterior cerebral artery. The tumor is usually supplied by the neck and the external carotid artery. Pathological blood vessels in the intracranial tumor area, due to the rich blood supply of the tumor, the tumor staining in the venous phase is clear, showing a thick platy shadow, which has the significance of localization and qualitative diagnosis.
3. CT scan showed that the tumor was located in a uniform density, enhanced group shadow block, the edge was intact, and the brain tissue edema band was often seen around the tumor.
4. MRI scan tumor signal is similar to gray matter, T1 weighted image is low to equal signal, T2 weighted image is equal or high signal, tumor boundary is clear, capsule and drainage vein are often seen, skull change can also be seen, horizontal position And coronal radiographs clearly show the relationship between the tumor and adjacent structures.
Diagnosis
Diagnosis and differentiation of brain convex meningioma
Usually, when the volume of meningiomas is very large, the diagnosis is relatively easy. Before the 1970s, the diagnosis of this disease relied mainly on the flat film and cerebral angiography. After the 1970s, CT was applied to the clinic, and the disease can be diagnosed very clearly. And more clearly than MRI, because in the latter image sometimes tumors and edema mixed together, affecting qualitative diagnosis, such as preoperative suspected tumor and sagittal sinus, need to be confirmed by cerebral angiography or MRI, of course, for diagnosis Convex meningioma, cerebral angiography is not required.
Glioma in different parts of the cerebral convex surface generally grow faster than meningioma. According to the different convex parts of the brain, the symptoms are different, but the corresponding symptoms appear earlier and heavier than the same part of the meningioma. The glioma of the frontal pole is difficult to distinguish from meningiomas of the same site at an early stage, but once its clinical symptoms appear, it progresses rapidly, and cerebral angiography shows the vascular displacement of the corresponding part.
