凸面脑膜瘤脑膜尾征其硬膜侵袭性的临床研究

Clinical Study on Dural ＂Tail＂ Sign and EndocraniumS Invasion of the Convex Meningiomas

目的 明确凸面脑膜瘤脑膜尾征的临床意义及其对应硬脑膜（DTSM）的肿瘤侵袭情况并探讨影响术中硬脑膜的切除范围.方法 选取Simpson I级的凸面脑膜瘤53例,依术前MRI检查图像上是否可见脑膜尾征分为两组.术中均取肿瘤基底周边至少20mm的硬脑膜,随机切取0mm,1～5mm,6～10mm,〉10mm分段与瘤体均行病理切片HE染色光镜检查,瘤体标本亦行增殖细胞核抗原（PCNA）和血管内皮细胞生长因子（VEGF）免疫组织化学染色观察,并进行统计学分析.结果 瘤周硬脑膜肿瘤细胞侵袭范围主要集中在0～5mm范围,由肿瘤基底向周围（以5mm为单位）硬脑膜浸润范围显著递减.VEGF和PCNA免疫组化表达强度与瘤周硬膜侵袭情况存在相关性.结论 有无脑膜尾征对判断瘤周硬脑膜侵袭无指导性意义,应对凸面脑膜瘤瘤周硬脑膜进行一定程度的侵袭性切除.

Objective To identify the clinical significance and corresponding endocranium pathology of the dural ＂tail＂ sign（DTS） of the brain convex meningiomas and to determine the best excision scope. Methods Fifty-three cases of convex menigioma belong to Simpson I level were selected, and were divided into one group with DTS and another group without DTS according to their MR images. The dural mater around the basement of tumors was resected and stochastically divided into four sections （0mm, 1 - 5 mm,6 - 10mm and more than 10mm ） for pathological inspection. Re- suits The scope of tumor cells invading the dural mater was mostly within 5mm. The probability of invasion decreases significantly as the distance away from the base of tumor increases（ based on 5mm ）. Conclusion DTS is not the criterion of the endocraniumg invasion degree. The probability of invasion decreases significantly as the distance away from the base of tumor increases（ based on 5mm）. Convex meningioma surgery should excise a portion of endocranium.