• Journal of Korean Neurosurgical Society
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• 제30권10호
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• pp.1200-1209
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• 2001

Objective : A thorough understanding of the related venous structure is mandatory for successful removal of the petroclival meningiomas. This study was planned to investigate the guideline for safe ligation and incision of transverse or sigmoid sinuses and the importance of drainage pattern of vein of $Labb{\acute{e}}$ in surgical removal of petroclival meningiomas. Patients and Methods : The authors reviewed the venogram of the consecutive 37 cases of petroclival meningiomas and retrospectively analyzed their surgical findings. The drainage pattern of confluence of Herophili was classified as Type A(confluent & equal on both sides), Type B(confluent & non-dominant on tumor side), Type C(confluent & dominant on tumor side) and Type D(unilateral drainage only) as these findings gave the information on safe ligation and resection of the sinus. Usefulness of intraoperative test clamping of sinus for safe ligation was also reviewed. The vein of $Labb{\acute{e}}$ was analyzed with respect to its draining point and its collaterals to other superficial veins. Results : Contraindications of the sinus ligation and resection according to the drainage pattern at the confluence of Herophili were Type C(n=10, 27%)and Type D(n=4, 11%). Patients with Type A(n=12, 32%)and Type B(n=11, 30%) were tolerable to sinus ligation ipsilateral to tumor, if the test clamping proved to be safe. Identification of no brain swelling, after intraoperative test clamping of the sinus for more than 30 minutes performed in 7 out of 11 cases, was a reliable indicator of safe sinus ligation. The drainage pattern of the vein of $Labb{\acute{e}}$, especially low-lying type, could predict the possibility of postoperative hemorrhage and infarction. Its drainage into tentorium or superior petrosal sinus, however, made the transtentorial approach impossible, leading to restricted operative field. Conclusion : For a successful removal of the petroclival meningiomas preoperative venogram should be examined carefully. The extent of exposure in a planned approach can be estimated by analyzing the variation of sinuses and the drainage pattern of vein of $Labb{\acute{e}}$.

• Journal of Korean Neurosurgical Society
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• 제30권sup1호
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• pp.30-36
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• 2001

1) 소뇌교각부 수막종의 빈도는 1.6%, 소뇌교각부 종양의 16%를 차지했고, 14례(82%)가 여성 이었다. 2) 증상은 청신경 장애(12례), 두통(10례), 소뇌장애(9례) 순이었다. 3) 종양은 주로 천막으로 확장 되었고(11례), 병리소견은 16례(94%)에서 양성 이었다. 4) 11례에서 내이도의 후방에, 3례에서 전방에 종양이 위치했고 3례에서는 en-plaque형 수막종 이었다. 5) 수술은 모두 S상 정맥동 후방접근법을 시행하여 14례에서 전적출을 시행하였다. 이중 1례에서 방사선 치료를 시행하였으며, 아전적출을 시행한 3례중 2례에서 방사선 치료를 시행하였다. 6) 제 7 및 8 뇌신경 복합체는 9례에서 종양의 전방에, 4례에서 종양의 후방에 위치했다. 7) 수술후 장기 추적관찰 결과는 16례에서 양호하였으며, 1례에서 사망하였다. 추적검사상 1례에서 재발하였다.