恶性脑膜瘤的诊断及治疗(附16例分析)

Diagnosis and treatment of malignant meningioma(a report of 16 cases)

目的探讨恶性(WHOⅢ级)脑膜瘤的诊断及治疗方法。方法回顾性分析16例WHOⅢ级脑膜瘤患者的临床资料。结果本组患者临床表现主要为头痛、头晕等高颅内压症状。MRI或CT表现主要为肿瘤分叶、不均匀强化、边界不清、瘤周水肿重,少数有脑膜尾征等。16例患者共行30次显微手术。病理类型为间变型10例,横纹肌样型2例,乳头状型2例,砂粒体型术后恶变2例。手术切除分级为SimpsonⅠ级7例、Ⅱ级8例、Ⅳ级1例,手术切除分级与肿瘤部位、是否复发、瘤周水肿程度、基底宽窄、术中出血量有关(P均<0.05),而与病理类型、Ki-67值、肿瘤大小无关。14例患者完成随访,术后1年,肿瘤复发6例、死亡3例;术后3年,肿瘤复发11例、死亡8例;术后5年,肿瘤复发11例、死亡10例;术后10年,肿瘤复发13例、死亡11例。结论恶性脑膜瘤临床表现无特异性,MRI或CT检查有助于术前诊断,确诊主要依靠病理诊断,治疗首选显微手术切除,预后较差。

Objective To investigate the diagnosis and treatment of malignant（ WHO grade Ⅲ） meningiomas.Method The clinical data of 16 cases of patients with WHO grade Ⅲ meningioma were retrospectively analyzed. Results The clinical manifestations of the patients were the high intracranial pressure symptoms such as headache,dizziness and so on. MRI or CT mainly showed that the tumor shape was irregular,the enhancement was inhomogeneous,the boundary was unclear,the peritumoral edema was heavy and some had the dural tail sign. A total of 16 patients underwent microsurgery for 30 times. The pathologic types： 10 cases of anaplastic type,2 cases of rhabdoid type,2 cases of papillary type and2 cases of postoperative malignant psammomatous. Surgical resection grade Simpson 1 level was found in 7 cases,8 cases of grade II and 1 case of grade Ⅳ. The surgical resection grade was related with the tumor location,whether recurrence,degree of peritumoral edema,basal width and the amount of bleeding（ all P〈0. 05）,but was not related with the pathological type,Ki-67 values and tumor size. Fourteen patients were followed up,one year after surgery,6 cases recurred and 3cases died; three years after sergery,11 cases had tumor recurrence and 8 cases died; five years after surgery,11 cases had tumor recurrence and 10 cases died; ten years after surgery,13 cases had tumor recurrence and 11 cases died. Conclusions The clinical manifestations of malignant meningioma are not specific. MRI or CT examination is helpful for preoperative diagnosis,and the diagnosis mainly depends on the pathological diagnosis. The microsurgical resection treatment is the first choice,but the prognosis is poor.