円蓋部・傍矢状洞部・大脳鎌髄膜腫

Convexity Meningioma, Parasagittal Meningioma, Falx Meningioma

Point

・円蓋部・傍矢状洞部・大脳鎌髄膜腫の摘出において，必要とされる基本的手術手技や手術戦略は共通している．

・内減圧によって生じたスペースに集めるように腫瘍を牽引することで，周囲脳を牽引することなく腫瘍を剝離することが可能となる．

・術後の静脈灌流障害を避けるために，皮質静脈や架橋静脈の温存に留意した手術を心掛ける必要がある．

＊本論文中、［Video］マークのある図につきましては、関連する動画を見ることができます（公開期間：2027年8月まで）。

　During surgery for meningioma, basic surgical techniques and strategies required for the removal of the tumor are common, particularly for tumors located superficially, such as convexity, parasagittal, and falx meningiomas. Four basic surgical techniques, including detachment; devascularization; debulking; and dissection should be combined and repeated in appropriate sequence, tailored to the specific conditions of each tumor. This eventually enables the total circumferential dissection of the tumor from the surrounding tissues. It is essential to retract the tumor towards the space created at the tumor center through internal debulking, rather than retracting the normal brain, to avoid damage to the surrounding brain tissue. During surgery for parasagittal meningioma with venous sinus occlusion, it is crucial to preserve the cortical veins that have developed as collateral pathways to prevent venous complications. During surgery for falx meningioma, the selection of a surgical approach including a contralateral approach based on factors such as the development of bridging veins and significant peritumoral brain edema is required. In this article, detailed surgical procedures for convexity meningioma, parasagittal meningioma, and falx meningioma were described focusing on the application of fundamental surgical techniques tailored to each tumor type.