前床突脑膜瘤的手术效果分析

Analysis of surgical efficacy of anterior clinoid meningiomas

目的探讨前床突脑膜瘤的手术效果以及影响肿瘤能否全切除的因素。方法回顾性分析1996年6月至2020年6月于海军军医大学附属长征医院神经外科行手术治疗的145例前床突脑膜瘤患者的临床资料。145例患者中,采用标准翼点入路84例,改良翼点入路46例,眶颧入路15例。通过Simpson分级评估肿瘤切除程度。通过单因素和多因素logistic回归分析方法探讨影响肿瘤切除程度的因素。通过临床随访评估症状的改善情况,行影像学随访评估肿瘤有无复发结果145例患者中,肿瘤全切除(Simpson Ⅰ~Ⅲ级)98例(67.6%),肿瘤部分切除(Simpson Ⅳ级)或单纯减压(Simpson Ⅴ级)47例(32.4%)。121例患者获随访,随汸时间为1~24(7.6±5.2)年术前视力下降的62例患者中,术后视力较术前改善32例(51.6%),无变化25例(40.3%),下降5例(8.1%)。随访期间肿瘤全切除患者的复发率为3.8%(3/78),未全切除患者的肿瘤复发或进展的比率为23.3%(10/43)。单因素分析结果表明,肿瘤的最大径、肿瘤对颈内动脉和海绵窦的侵袭程度及术前视力下降可能与肿瘤的切除程度有关(均P<0.05)。多因素logistic回归分析结果显示,肿瘤最大径(OR=3.21,95%CI:1.05~10.39,P<0.01)、肿瘤对颈内动脉及海绵窦的侵袭程度(OR=7.25,95%CI:2.35~21.64,P<0.01)为影响肿瘤全切除的独立危险因素,肿瘤最大径≤3 cm及肿瘤未完全包绕颈内动脉或未侵及海绵窦的患者手术全切除率较高,分别为74.8%(89/119)和82.8%(72/87)。结论对于前床突脑膜瘤,根据具体情况采用相应的手术策略,可获得较高的肿瘤全切除率,且复发率低。最大径<3 cm以及仅部分包绕颈内动脉或未侵及海绵窦的前床突脑膜瘤更易获得全切除。

Objective To investigate the surgical outcomes of anterior clinoid meningiomas and to explore the factors affecting whether the tumor can be completely removed.Methods The clinical data of 145 patients with anterior clinoid meningiomas treated at Department of Neurosurgery,Changzheng Hospital,Navy Military Medical University from June 1996 to June 2020 were retrospectively analyzed.Patients undement microsurgery via standard pterional approach in 84 cases,via modified pterional approach in 46 cases anti via orbitozygomatic approach in 15 cases.The degree of tumor resection was evaluated using the Simpson classification system.The factors influencing the degree of tumor resection were analyzed using univariate and multivariate logistic regression analyses.The improvement of symptoms was evaluated by clinical follow-up,and imaging follow-up was conducted to identify the tumor recurrence.Results Among all 145 patients,98 cases(67.6%)underwent gross total resection(Simpson grade Ⅰ-Ⅲ),and 47 cases(32.4%)underwent partial tumor resection(Simpson grade Ⅳ)or merely decompression(Simpson grade Ⅴ).A total of 121 patients were followed up for 1-24(7.6±5.2)years.Among the 62 patients with preoperative decreased visual acuity,visual acuity was improved in 32 patients(51.6%),remained unchanged in 25(40.3%)and decreased in 5(8.1%)post operation.During follow-up,the recurrence rate was 3.8%(3/78)in patients with gross total resection of tumor and the recunence or progress rate was 23.3%(10/43)in patients with partial resection.Univariate analysis results showed that the maximum diameter of tumor,invasion of the internal carotid artery and cavernous sinus as well as the decrease of preoperative visual acuity may be related to the extent of tumor resection(all P<0.05).Multivariate logistic regression analysis showed that the maximum tumor diameter(OR=3.21,95%CI:1.05-10.39,P<0.01)and the degree of invasion of internal carotid artery and cavernous sinus(OR=7.25,95%CI:2.35-21.64,P<0.01)were independent risk factors for total tumor resection.The gross total resection rate was 74.8%(89/119)in the patients with the maximum diameter of tumor≤3 cm and 82.8%(72/87)in patients with the tumor partially surrounding the internal carotid artery or not invading the cavernous sinus.Conclusions According to the specific situation,the appropriate surgical strategy can lead to high gross total resection rate and low recurrence rate.Anterior clinoid meningiomas with the maximum diameter≤3 cm and partially surrounding the internal carotid artery or without invasion of the cavernous sinus are more likely to be completely removed.