颅内透明细胞型脑膜瘤（附21例报告）

Intracranial clear cell meningioma（repot of 21 cases and literature review）

目的 探讨颅内透明细胞型脑膜瘤（CCM）的临床特征和外科治疗.方法 回顾性分析首都医科大学附属北京天坛医院神经外科2003年1月至2013年8月收治并经组织病理学证实的21例颅内CCM患者的临床资料,包括影像学、手术情况、组织病理学和随访结果.结果 21例CCM占同期颅内脑膜瘤的0.23％ （21/9 167）,其中男7例,女14例,平均年龄27.5岁.肿瘤位于幕上10例,颅底11例,幕上CCM瘤周水肿发生率为80％ （8/10）,水肿明显且范围较大;颅底CCM对周围硬膜及骨质破坏发生率达73％ （7/11）.首次手术按照脑膜瘤切除程度Simpson分级：Ⅰ级7例,Ⅱ级和Ⅲ级各3例,Ⅳ级8例.8例行Ki-67增值指数检测,平均值为11.25％ （5％ ～30％）.20例获得随访,平均随访时间为41个月（11 ～ 137个月）,肿瘤复发率为60％ （12/20）,死亡3例（15％）.首次术后行伽玛刀治疗5例,射波刀治疗1例.结论 颅内CCM是中枢神经系统较少见的脑膜瘤亚型,影像学及组织病理学特点不同于良性脑膜瘤.手术切除虽是治疗CCM的主要手段,但全切率低,易复发.残余肿瘤行伽玛刀治疗可降低复发率和延长复发时间.

Objective To investigate the clinical features and treatment of intracranial clear cell meningioma.Methods We retrospectively reviewed 21 cases of intracranial clear cell meningioma hospitalized in our institute between 2003 and 2013.The clinical data included the images,surgical treatment,immunohistochemistry and the results of follow-up.Results The 21 patients who constituted 0.23% of the total 9 167 intracranial meningiomas included 7 males and 14 females.The average age was 27 years old.The edema rate of the 10 cases in the superior tentorium region was 80%,and the damage rate of the 11 skull base tumors to the surrounding bone and periosteom was 73%.Resection of Simpson Ⅰ grade was achieved in 7 patients,Simpson Ⅱ in 3,Simpson Ⅲ in 3 cases and Simpson Ⅳ in 8.The average Ki-67 index was 11.25%.The mean follow-up period was 41 months,and 20 cases were followed-up.3cases died.5 cases were treated with gamma knife after the first operation,and 1 case accepted Cyberknife.Conclusions Intracranial CCM was a rare subtype of the intracranial meningiomas.Its imaging and histopathologic characteristics were different from those of benign meningiomas.Surgical resection was the main treatment,but it is difficult to reach entirely total resection.A high recurrence rate was found in intracranial CCM.Gamma knife surgery for the residual tumor could prolong the recurrence time and reduce the recurrence rate.