非颅底位置深在脑膜瘤手术切除的影响因素分析

Influencing Factors of Resection in Non Skull Base Deep-seated Meningiomas

目的探讨非颅底位置深在脑膜瘤手术切除程度的影响因素,为今后评估该类脑膜瘤的治疗提供参考。方法回顾分析天津市环湖医院神经外科于2011年1月至2015年6月手术治疗的67例非颅底位置深在脑膜瘤患者的病历资料。非颅底位置深在脑膜瘤限定为窦旁(上矢状窦旁脑膜瘤限定为肿瘤基底靠近大脑镰且埋被于皮层下、下矢状窦、直窦)、镰旁、脑室内和小脑幕脑膜瘤。将67例患者的性别、年龄、主诉、病程、既往病史、神经科查体阳性体征、肿瘤部位、大小、形状、增强程度、钙化、瘤周水肿、神经血管包绕、侵袭性、边界及病理亚型等因素与术中肿瘤是否全切进行单因素分析,筛选出影响肿瘤切除的相关因素,并对有统计学意义的因素进行二分类logistic逐步回归分析,同时记录患者术后并发症及随访情况。结果肿瘤侵袭性、瘤周水肿和神经血管包绕是影响肿瘤是否全切的3个独立危险因素,其中肿瘤侵袭性是主要因素,肿瘤具有侵袭性不能手术全切除的危险是不具有侵袭性肿瘤的9.161倍。结论对于非颅底位置深在脑膜瘤,根据肿瘤侵袭性、瘤周水肿和神经血管包绕情况可以比较客观地评估脑膜瘤切除程度。术前仔细研读患者影像学资料,术中谨慎处理脑膜瘤与周围组织的关系,可有效提高该类患者的治疗效果。

Objective To explore the influencing factors of the extent of the surgical resection in non skull base deep-seated meningiomas, so as to provide a reference for the evaluation of the treatment. Methods A total of 67 cases of non skull base deep-seated meningioma in Tianjin Hua- nhu Hospital from January 2011 to June 2015 were retrospectively analyzed. Non skull base deep-seated meningiomas were limited to para sinus （superior parasagittal meningiomas were limited to the base of the tumor near the falx cerebri and buried in the cortex, inferior sagittal sinus, and straight sinus ）, faLx, intraventricular and tentorium of cerebellum. The patients＇ general information, clinical features, preoperative imaging infor- marion, intraoperative condition and pathologic classification of meningiomas were recorded, univariate analysis （chi-square test or Fisher test ） was performed to screen out the factors related to tumor resection, and factors with statistically significant differences as independent variables were used for binary logistic stepwise regression analysis, at the same rime, complication and postoperative follow-up were recorded. Results Tumor in- vasiveness, peritumoral edema, and vessels and nerves wrap around were three independent risk factors for tumor residual, and tumor invasiveness was the main risk factor, the risk of not complete resection of tumor with invasiveness was 9.161 times of that without invasiveness. Conclusion For non skull base deep-seated meningioma, the extent of the tumor resection can be objectively evaluated by tumor invasiveness, peritumoral ede- ma and vessels and nerves wrap around. Studying imaging of patients carehdly before surgery and handling the tissue surrounding meningioma cau- tiously in operation can effectively improve the curative effect of these patients.