Application of CUSA in large meningioma resection beside the sagittal sinus and cerebral falx

Abstract:

Objective：To discuss the clinical significance and application of cavitron ultrasonic surgical aspirator（CUSA） in menin－gioma beside the sagittal sinus and falx cerebri resection. Methods：Fifty-one cases of meningioma beside the sagittal sinus and falx cerebri in our hospital were divided into A，B groups depending on the application of CUSA by retrospective analysis. Twenty-seven cases using CUSA with bipolar electric coagulation resection were enrolled in A group，24 cases using tissue scissors with bipolar co－agulation conventional resection were enrolled in B group. Tumor resection rate，operative time，blood loss，postoperative intracranial pressure（ICP），average hospitalization time，mannitol dose，delayed cerebral hemorrhage were compared between two groups. Results：Based on Simpson standard Ⅰ，Ⅱ，Ⅲ（grade），there were 23，3，1（case） in group A while 15，5，4 in group B；there was no difference in removal rate between two groups（P=0.125）. The average hospitalization time of group A and group B was （15.11±2.50） d and （19.71±4.79） d，respectively，with statistically significant differences between groups A and B（P=0.019）. The operative time was （4.27±0.27） h and （4.86±0.54） h，respectively. The blood was （631.48±240.65） ml and（1050.00±521.70） ml，respectively，with statistically significant differences between groups A and B（P=0.006，P=0.029）. There was no significant difference in ICP within 6 h between two groups（P=0.138）. The ICP was （11.30±3.81） mmHg and （12.59±5.52 ） mmHg in group A within 6-72 h and at 72 h after operation；the ICP was （13.96±9.95） mmHg and （16.83±8.98） mmHg in group B within 6-72 h and at 72 h after operation，with statistically significant differences between groups A and B（P=0.011，P=0.031）. One case of acute renal failure and no case of de－layed cerebral hemorrhage were observed in group A. Four cases of acute renal failure and five cases of delayed cerebral hemorrhage were observed in group B，among which three cases underwent removal of hematoma craniotomy. In 3-month follow-up，24 cases re－covered well and 3 cases recovered poorly in group A. No death case and serious case was observed. Conclusion：In meningioma beside the sagittal sinus and falx cerebri resection，although we can not increase the rate of tumor resection，CUSA is still a practical and effective technology that can shorten the operation time，reduce complications，improve surgical outcome and prognosis.