Abstract:Elderly women who seek medical treatment for "tumor found after multiple postoperative radiotherapy for parasinus meningioma" should consider tumor ** after examination in the hospital. Due to the patient's serious condition and high surgical risk, I went to our hospital for medical treatment, and I successfully removed the patient's bilateral top parasagittal sinus tumor through surgery, and the patient's condition gradually improved after positive surgery.
1. Comparison before and after surgery
At the time of admission, the patient was in a reasonable condition, with obvious headache and wheelchair accessPhysical examination: muscle strength of both upper limbs, muscle strength of left lower limb, muscle strength of right lower limb;Superficial sensation in the trunk and extremities is normal, and deep sensation in both lower extremities is hypoesthesia. MRI of the brain: suggests bilateral parietal parasagittal sinus** anaplastic meningioma, with the tumor predominantly on the left apex and invasion of the sagittal sinus involving the right apex. After completing the relevant examinations, we performed bilateral top parasagittal sinus ** anaplastic meningioma enlargement resection + dural enlargement repair + bone flap titanium mesh reduction and fixation for the patient under general anesthesia, and the operation went smoothly. Postoperative headache relief. Repeat CT of the brain: suggests complete tumor resection.
2. Preoperative diagnosis
The patient had a clear history of anaplastic meningioma after multiple postoperatives and radiotherapy, and had a recent decline in muscle strength and headache in both lower limbs. MRI of the brain: suggests bilateral parietal parasagittal sinus** anaplastic meningioma, with the tumor predominantly on the left apex and invasion of the sagittal sinus involving the right apex. Preoperative diagnosis should be based on postoperative anaplastic meningioma**. After admission, we should improve preoperative examinations such as blood routine, biochemistry, coagulation, electrocardiogram, cardiac ultrasound, and Holter electrocardiogram, and although the patient's heart disease is serious, in order to save the patient's life and improve neurological function, we still recommend the patient to undergo active surgery.
Third, the design scheme
The diagnosis of anaplastic meningioma was confirmed after multiple postoperatives and radiotherapyAnaplastic meningioma is not sensitive to chemoradiotherapy, and surgical resection is the main method. Due to multiple surgeries, the local structure is deranged, the adhesions are tight, and the risk of nerve injury is highMoreover, the tumor invades the sagittal sinus, and there is a high risk of intraoperative venous sinus and cortical venous injuryTherefore, we decided to open a bilateral craniotomy to fully expose the bilateral apex and sagittal sinuses to maximize tumor resection and prolong tumor time.
Fourth, the first effect
Before the operation, the patient and family were fully explained to the patient and family about the necessity of the surgery and the risks associated with the surgery, and the consent and cooperation of the patient and family were obtained. After fully improving the preoperative preparations, bilateral parietal parasagittal sinus** anaplastic meningioma enlargement resection + dural enlargement repair + bone flap titanium mesh reduction and fixation was performed under general anesthesiaThe surgery went smoothly and took 4 hours. The patient is awake and returns to the ward. Brain CT was re-examined 4 hours after surgery: the tumor was completely resected and no abnormalities were found.
FiveReview summary
After the operation, we actively gave dehydration, hormones, etc., which fully alleviated the cerebral edema, and the patient recovered smoothly: the headache was relieved, and the muscle strength of both lower limbs gradually improved. After 3 months of surgery, the patient's general condition was okay, with muscle strength level of left lower limb and muscle strength level of right lower limb. Repeat MRI of the skull: no obvious tumor**.
6. Postoperative precautions
1. Manage the surgical incision after surgery to reduce the risk of local infection and even intracranial infection.
2. The patient has multiple postoperative scar incisions, and the suture removal is postponed.
3. After discharge, if you have fever, headache, nausea, vomiting and other uncomfortable symptoms, seek medical treatment in time.
4. Outpatient follow-up.