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Objective:Large intracranial supratentorial meningioma (greater than5cm in diameter) is often slowly growing, placeholder effect obviously, richblood supply, intraoperative bleeding is more, surgical removal of theplaceholder remove oppression, prevention and treatment of nerve dysfunction,eliminate the intracranial pressure, is the purpose of treatment.But the patient’squality of life is closely linked to the postoperative complications, tumorpathology, tumor location and whether there is nerve dysfunction.This studyis to discuss the causes of supratentorial large meningiomas of postoperativeintracranial hemorrhage again and how to effectively prevent.With the rapiddevelopment of science and technology, the neurosurgery technology of underthe microscope and a series of hemostatic materials constantly improve,postoperative intracranial hemorrhage effectively reduce.But the largeintracranial meningioma tumor has its own particularity, the surgery itself for along time, intraoperative blood loss, cerebrospinal fluid leakage losscomponents, placeholder effect to remove after tumor resection, brain tissuedue to long time compression cannot quickly raised reset, tumor cavity is large,brain tissue is easy to collapse cause the vein and part of the venous drainageby stretch, tear, easy to form postoperative subdural hematoma;And some likeWang Zhongcheng think that the dura mater of brain vault of frontotemporaland on the top of the skull is relatively loose, large variation of thepostoperative intracranial pressure can lead to the emergence of epiduralhematoma;Around the tumor cavity pressure for a long time, local oppressionto cancel cause cerebral perfusion pressure breakthrough bleeding, because oftumor cavity pressure, a small amount of slow bleeding is easy to form alarger tumor cavity hematoma.As is known to us,hematoma caused byoppression placeholder effect late hematoma caused by intracranial pressure, leading to a series of serious effects, with the absorption of hematoma, due topathological physiological reaction of organism produces local thrombin, freeradicals to further damage the brain, such as physical and mental harm topatients.So it is necessary to take measures to prevent the large intracranialsupratentorial tumor resection after brain organizations collapsed bridge veinrupture hemorrhage and tumor cavity around the cerebral perfusion causebleeding.The purpose of this study is to investigate the large meningiomasintracranial supratentorial craniotomy (greater than5cm in diameter) tumorcavity of postoperative hematoma and subdural and epidural hematoma causesand prevention measures.Methods: General data (1): a retrospective analysis from January2012to December2013, the large meningiomas intracranial supratentorial tumor(tumor diameter greater than5cm) surgery patients, record the patient’s basicinformation,such as age and gender.The preoperative imaging data aresupported (including skull CT and MRI).Preoperative routine check routineblood clotting, blood routine, biochemical items, electrocardiogram, chestX-ray, preoperative examination such as the four, preoperative all patients2weeks without a history of oral anticoagulant and antiplatelet drugs such asaspirin.Remove the patients with high blood pressure, diabetes andcoagulopathy, a total of131patients in the second hospital of Hebei MedicalUniversity.Perioperative well control of blood pressure, blood sugar, allpatients undergoing elective endotracheal intubation downward surgicaloperation under general anesthesia, according to the location of theintracranial tumors take appropriate surgical approach, under the microscopecut: total or subtotal resection, according to the tumor cavity after tumorresection having or not having water capsule placed,the study is dividedinto water sac group and non water sac group, water capsule group61cases,the non water sac group70cases, water sac group applicate14or16F doublelumen catheter, carefully cut off the tip part, injection of saline10ml to50mlinto tumor cavity, tumor cavity by poking holes in water sac to the scalpexternal drainage bag, water bag size depends on the size of the residual cavity after tumor resection, degree of collapse of the surrounding brain tissue,presence of bridge vein pull and tore torsion, closely sutured dura mater,tumor cavity drainage tube flaw of dura mater available extended fascia suture,epidural routine indwelling drainage tube, conventional closed cranial;Whereno water sac tumor cavity, tumor cavity filled with saline, closely sutured duramater, epidural routine indwelling drainage tube, the conventional closedcranial, drainage tube are external drainage bag.After8hours to24hours ofregular review skull CT, according to skull CT in patients with symptomaticintracranial hemorrhage were assessed.Postoperative1day to3day routineuse of hemostatic drugs. For water capsule group patients after review theskull CT within24hours to48hours after surgery，the saline water in watersac will be released by extracranial hole in batches. The epidural drainage tubeand tumor cavity tube will be pulled out in48hours.After review the skull CTwithin48hours after surgery, the epidural drainage tube of patients in nonwater sac group will be pulled out.(2)(8hours to24hours) The skull CT ofpostoperation as the evaluation of symptomatic intracranial hemorrhage, todetermine the bleeding by CT. And more than10ml bleeding will bejudgement for intracranial hemorrhage.The result is as follows:water sacgroups: male patients31cases, female patients30cases, minimum age36years old, biggest76years old.4cases with hint antrum of tumor hemorrhageafter review postoperative skull CT,1case with subdural hematoma,total5cases.Non water sac group: male patients34cases, female patients36cases,minimum age38years old, biggest74years old.12cases with hint antrum oftumor hemorrhage after review postoperative skull CT,3cases with subduralhematoma,1cases with epidural hematoma, total16cases.(3) Data descriptionand statistic, measurement data used mean±standard deviation, median(interquartile spacing), the count data were expressed as frequency andpercentage (%); measurement data comparison was analyzed by t test ornonparametric test, count data was analyzed by the chi-square test or Fisher’sexact probability method, all data were analyzed by SPSS13.0software,inspection level α=0.05.P<0.05are statistically significant. Results:1gender composition: male patients65cases (49.6%),female patients66cases (50.4%), the sex ratio of0.98:1.31cases of male patients (50.8%) and30cases of female patients (49.2%) in water sac group;34cases of malepatients (48.6%) and36cases of female patients (51.4%)in non water sacgroup; There was no statistical differences between the male and femalegender (chi-square=0.066, P>0.066).2Age: Overall patient age range of27-76years old,average age(52.39-11.74). Age range of36~76-year-old age range in water sac group,average age (51.49+11.19);Age range of38to74years old in non water sacgroup, average age (52.97-12.13).Compared two groups of age, there was nostatistically significant difference (t=0.644, P=0.521).3Water sac group:5cases with postoperative intracranial hemorrhageagain,56cases with non-postoperative intracranial hemorrhage again; Nonwater sac group:16cases with postoperative intracranial hemorrhage again,54cases with non-postoperative intracranial hemorrhage again. comparing thetwo groups was statistically difference ((chi-square=5.20, P <0.05).Conclusions: The study show that for large meningiomas intracranialsupratentorial tumor cavity after placing water sac can effectively reduce therisk of postoperative intracranial hemorrhage again.The study has certainclinical significance and is worth promoting.
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