Parasagittal meningioma
Introduction
Introduction of parasagittal meningioma Parasagittal meningioma refers to a meningioma with a tumor base attached to the superior sagittal sinus and filled with a sagittal sinus angle. There is no brain tissue between the tumor and the superior sagittal sinus. basic knowledge The proportion of illness: 0.003% Susceptible people: no special people Mode of infection: non-infectious Complications: air embolism, cerebral infarction, edema
Cause
Cause of parasagittal meningioma
The sagittal sinus meningiomas are most common in the carpel and fiber types. The tumor can be grown in the following ways: 1 The tumor base is located on one side of the sagittal sinus wall, which grows convexly to the brain, and the tumor body is embedded in the inner side of the cerebral hemisphere; Involved in the cerebral palsy, the basement extends along the cerebral palsy, and the main body of the tumor is located in one side of the longitudinal fissure pool; 3 the tumor grows from the lateral side of the sagittal sinus, spans the superior sagittal sinus and surrounds it, and the parasagittal meningioma often Partial or total obstruction of the superior sagittal sinus cavity, the tumor often erodes the dura mater and skull of the adjacent site, causing the skull to proliferate significantly and bulge outward. The tumor is mainly supplied by the ipsilateral meningeal artery, from the anterior and posterior cerebral arteries. The pia mater is also involved in its blood supply.
Prevention
Prevention of parasagittal meningioma
Should be light, mainly eat fruits and vegetables, a reasonable mix of meals, pay attention to adequate nutrition. Avoid spicy. Avoid greasy alcohol and tobacco. Avoid eating cold food.
Complication
Complications of parasagittal meningioma Complications, air embolism, cerebral infarction edema
If surgery is performed, the following complications may occur:
1. Severe cerebral edema after operation: due to damage to the central vein or other important reflux veins during operation, dehydration and intracranial pressure should be performed after the occurrence.
2. Postoperative limb movement or dysfunction such as urination: Due to the damage of important functional areas during surgery, it can be used to improve microcirculation drugs, neuro-metabolic drugs, energy drugs, etc. to help them recover.
3. Air embolism: It is a serious complication, which can cause death or severe disability of the patient. Once it occurs, it should be actively rescued. Those with disabilities should be treated according to cerebral infarction.
Symptom
Symptoms of parasagittal meningioma common symptoms sensory disorder mental disorder increased intracranial pressure, impaired nausea around the aqueduct
The sagittal sinus meningioma grows slowly. Although the brain tissue and the sagittal sinus do not produce symptoms in the early stage, the tumor has grown much when the patient has symptoms. As the tumor volume increases, the occupancy effect is obviously enhanced. Compression of adjacent brain tissue or superior sagittal sinus, affecting venous return, gradual increase in intracranial pressure, epilepsy and certain localized symptoms or signs, as well as small meningioma asymptomatic, for accidental discovery, there are some meningioma although volume is not Large, but with a large cystic change, or cerebral edema around the tumor is severe, so the symptoms of increased intracranial pressure, manifested as headache, nausea, vomiting, lack of energy, and even decreased vision, clinical examination can be seen optic disc edema.
Epilepsy is a common first symptom of this disease, which can be as high as 60% or more, especially in the sinus meningioma in the central region. The incidence of epilepsy can be as high as 73%, the location of the tumor is different, and the way of seizures is slightly different. Patients with tumors in the first 1/3 of the sinus often show epileptic seizures. One third of the tumor patients often present with focal seizures, or first episodes of systemic seizures; the latter third of tumor patients The incidence of epilepsy is low, and there may be a visual aura after the attack.
Mental disorders are common in the first 1/3 of meningioma of the sagittal sinus, which is reported to account for 59%. The group accounts for 22%. The patient may be demented, with apathy or euphoria, and some patients may even have personality changes. Older patients are often Misdiagnosed as senile dementia or cerebral arteriosclerosis.
Although the local symptoms of patients are relatively rare, they have certain localization significance. Patients with tumors located in the first 1/3 of the sagittal sinus can often present with mental symptoms such as euphoria, informality, indifference, even dementia, and personality changes. Etc., tumor patients occurring in 1/3 of the sagittal sinus may have contralateral limb weakness, sensory disturbances, etc., mostly with the feet and lower limbs as the weight, the upper limbs and the face are lighter. If the tumor is bilaterally grown, typical The lower extremity spasm of the lower extremity, the limbs are scissor-shaped, and should be differentiated from the bilateral lower extremity spastic paralysis caused by spinal cord lesions. The tumor patients located in the latter third are often involved in the occipital lobes, resulting in visual field defects or Lateral hemianopia can cause blindness in the later stages of bilateral development.
There is a visual field disorder in the sagittal sinus meningioma located in the occipital lobe, which is reported in the literature as 29%. In some patients, the skull part of the tumor is also visible.
Examine
Examination of parasagittal meningioma
1. Skull X-ray film
There is a certain significance. It is reported that the skull flat film can determine about 60% of the superior sagittal sinus meningioma, with local bone hyperplasia or thinning of the inner plate, and even the performance of worm-like destruction. The vascular changes can be seen in the affected meninges. The middle sulcus is deepened and distorted, the veins of the stenosis are dilated, and some tumors have calcified plaques.
2. Cerebral angiography
Before CT application, cerebral angiography is the main method for characterization of the parasagittal meningioma. The characteristic tumor staining and spheroidal blood supply artery imaging can be seen. The diagnostic value of current cerebral angiography for this disease lies in:
(1) Understand the blood supply in the blood supply artery and tumor of the tumor: the blood supply to the anterior 1/3 and middle 1/3 meningioma of the sagittal sinus is mainly from the anterior cerebral artery, and the posterior 1/3 of the tumor is mainly the posterior cerebral artery. At the same time, the middle meningeal artery can participate in blood supply. At this time, the middle meningeal artery can be thickened and twisted. If the tumor invades the skull, the superficial temporal artery can be seen to participate in blood supply.
(2) Intravenous and sinus phases of cerebral angiography: It can be seen that the tumor will be displaced by venous compression, and some sagittal sinuses will be interrupted by tumor obstruction. These contrast signs determine whether the tumor can be combined with the sagittal sinus. Excision is extremely helpful.
3. CT or MRI scan
It is the main method for the diagnosis of this disease. CT scan can show the shape of the superior sagittal sinus, equal density or high density shadow. The density is evenly increased when the scan is enhanced. The basal is connected with the sagittal sinus. Some patients can see the periorbital arc. In the low-density edema zone, in addition, the CT scan of the bone window image can show the change of the skull (Fig. 2). Compared with CT, MRI has improved tumor localization and qualitative. The tumor has more signals on the T1-weighted image, a few Low signal; high signal on the T2-weighted image, equal signal or low signal; the internal signal of the tumor may be uneven; after injection of Gd-DTPA, the tumor is obviously enhanced, and the MRI scan can clearly reflect the tumor and the sagittal sinus. relationship.
Diagnosis
Diagnosis and differentiation of parasagittal meningioma
At present, the diagnosis of this disease has been easily applied by CT or MRI. Most patients can be diagnosed at an early stage. CT bone window image and MRI can also provide damage to the skull adjacent to the tumor, providing more detailed surgery. Case.
Tumors with clear boundaries along the sagittal sinus should be differentiated from metastatic cancer. The latter has a short history, and the cerebral edema around the tumor is severe and extensive, and sometimes the primary cancer lesions of the lung, prostate, and ovary can be found.
