前床突脑膜瘤的显微手术治疗及疗效影响因素分析

Microsurgical removal and influencing factors of efficacy analysis of anterior clinoid meningiomas

目的探讨前床突脑膜瘤的手术治疗策略,并分析影响患者疗效的因素。方法回顾性分析中南大学湘雅医院神经外科2012年1月至2018年4月收治的51例前床突脑膜瘤患者的临床资料。所有患者均行经翼点入路或扩大翼点入路切除肿瘤。采用Simpson分级评估肿瘤的切除程度,以Karnofsky功能状态评分(KPS)评估患者的预后。应用单因素分析探讨影响患者肿瘤切除程度的因素。结果51例患者中,Simpson Ⅰ~Ⅱ级切除41例(80.4%),Ⅲ级切除7例(13.7%),Ⅳ级切除3例(5.9%)。术后51例均获随访,随访时间为(48.6±28.4)个月。肿瘤复发1例,肿瘤进展4例。末次随访时KPS评分为(90.3±9.6)分,高于出院时的(87.0±7.8)分和术前的(74.3±10.5)分(均P<0.01)。单因素分析结果表明,肿瘤与海绵窦的关系(P<0.001)、肿瘤的Al-Mefty分型(P<0.001)、肿瘤最大径(P=0.004)为影响前床突脑膜瘤患者肿瘤全切除的因素。结论未侵犯海绵窦内、最大径<2 cm、Al-Mefty分型为Ⅱ、Ⅲ型的前床突脑膜瘤更易获得全切除。术前根据肿瘤影像学特征,选择个体化手术方式,有利于最大程度地切除肿瘤并保护神经功能,从而改善患者的预后。

Objectives To investigate the strategy of surgical treatment for anterior clinoid meningiomas and to analyze the influencing factors of efficacy. Methods A retrospective review was performed on 51 patients with anterior clinoid meningioma who were consecutively admitted to Department of Neurosurgery, the Xiangya Hospital of Central South University from January 2012 to April 2018. All patients underwent tumor resection via the pterional approach or extended pterional approach. The extent of tumor resection was assessed using the Simpson classification. Karnofsky performance status (KPS) scale was used to evaluate the patents′ outcomes. Results Among all 51 patients, Simpson Ⅰ-Ⅱ resection was achieved in 41 (80.4%) cases,Ⅲ in 7 (13.7%) and Ⅳ in 3 (5.9%). All 51 patients were followed up. The postoperative follow-up duration was 48.6±28.4 months. Tumor recurrence and progression were identified in 1 case and 4 cases respectively. The KPS at the last visit was 90.3±9.6 and higher than that at discharge (87.0±7.8) and prior to operation (74.3±10.5)(both P<0.01). Univariate analysis indicated that the relationship between tumor and cavernous sinus (P<0.001), the tumor types (P<0.001) and the maximum diameter of tumor (P=0.004) are the risk factors influencing total resection of tumor. Conclusions Total resection seems to be easier to be achieved when the tumor has not invaded the cavernous sinus, the maximum diameter of the tumor is less than 2 cm and the Al-Mefty type is Ⅱ or Ⅲ. According to the radiological features of the tumor before surgery, surgical strategies for each patient could be customized, which contribute to maximal tumor resection and preservation of neurological function, thus improving the prognosis of patients.