侵袭性脑膜瘤的诊断和治疗

Diagnosis and treatment of aggressive meningiomas

目的探讨侵袭性脑膜瘤的临床特点和治疗方法。方法对手术治疗的52例侵袭性脑膜瘤患者的临床资料进行回顾性分析。肿瘤位于幕上凸面、镰窦旁、侧脑室内共44例,颅底6例,幕下2例。幕上肿瘤主要采用马蹄形瓣状开颅,幕下采用幕下旁正中切口。颅底肿瘤分别采用翼点、乙状窦后,额下入路。结果 52例患者共进行75次手术,其中1次手术34例,2次手术14例,3次手术3例,4次手术1例。手术后24例行普通放疗,4例行适形放疗,11例行γ-刀治疗。SimpsonⅠ级切除30例,Ⅱ级切除10例,Ⅲ级切除11例,Ⅳ级切除1例。出院后共有37例患者得到1个月-11年随访,7例随访到的Ⅲ级脑膜瘤全部复发。Ⅱ级脑膜瘤随访30例,其中16例患者尚未复发,14例患者复发。结论侵袭性脑膜瘤是颅内较少见肿瘤,预后较差。手术切除和手术后辅助放疗是延长患者生存期的重要手段。

Objective To explore clinical feature and therapeutic experiences of aggressive meningiomas. Methods The clinical dada of 52 patients with aggressive meningiomas who received the operation, were analyzed retrospectively. Of 52 cases,44 located in cerebral convexity,parasagital,parafalx and lateral ventricle,6 located in skull-base and 2 located in infratentorial space. Craniotomy of supratentorial tumors was performed through supratentorial horseshoe incision.Craniotomy of infratentorial tumors was performed through paramedian incision. Tumors of skull-base was performed through pterion approach,retrosigmoid approach and subfrontal approach respectively.Results 75 operations were carried out for 52 patients. Of them,only one operation for 34 patients,second operation for 14 patients,third operation for 3 patients,fourth operation for 1 patient. 24 patients underwent additional adjuvant general radiotherapy, 4 patients underwent conformal intensitymodulated radiotherapy and 11 patients underwent Gamma-knife radiotherapy. Simpson grade I resection was achieved for 30 patients,Simpson grade Ⅱ resection for 10 patients,Simpson grade Ⅲresection for 11 patients,and Simpson grade Ⅳ resection for 1 patients. 37 patients were followed up from one month to 11 years. Recurrences occurred for all 7 Grade Ⅲ meningioma patients. Of 30followed-up Grade Ⅱ meningioma patients,no recurrences occurred for 16 patients,recurrences occurred for 14 patients. Conclusions Aggressive meningioma were rare intracranial tumor. Its prognosis was poor. Surgical resection followed by radiotherapy were key means to prolong survival time of patients.