Microsurgical treatment for giant meningiomas in the central gyrus region

CHEN Zheng-gang; YANG Kun; WANG Zi-zheng; ZHOU Jian; WU Ran; YE Fu-yue; CING Wei

doi:10.13798/j.issn.1009-153X.2019.08.005

Abstract：Objective To explore the perioperative managements and surgical considerations of giant meningioma in the central gyrus region. Methods The clinical data of 18 patients with giant meningioma in the central gyrus region who underwent microsurgery from January 2008 to January 2016 were analyzed retrospectively. The experience of surgical treatment was summarized. Results Of 18 patients, Simpson grade I resection was performed in 13 patients, grade II resection in 3 and grade III resection in 2. The decraese in postoperative limb muscle strength occurred in 8 patients, postoperative epileptic seizures occurred in 6, and aggravation of cerebral edema occurred in 1 who underwent decompressive craniectomy. The results of 1 year follow-up showed that limb muscle strength returned to normal in 16 aptients, grade IV in 1, and long-term coma in 1. There was no epileptic seizures 1 year after the operation. The recurrence of tumor occurred in 1 patient 3 years and in 1 patient 5 years after the operation. Conclusions For microsurgical treatment of giant meningioma in the central gyrus region, the blood supply, nature and venous drainage of the tumors should be carefully evaluated before the operation; the DSA examination and embolism of partial blood supply artery should be performed when necessary; the cerebrospinal fluid should be drained by indwelling lumbar cistern drainage tube during the operation; the brain tissue traction should be reduced; the tumors should be resected in blocks; the drainage veins should be protected and the total rection of tumor should be made as far as possible. The measures including reasonable prevention of seizures, maintenance of blood pressure stability, and early rehabilitation treatment are helpful to the reduction of complications and improvement of treatment effect.