TCTI比值预测肿瘤质地在颅底中线脑膜瘤经鼻蝶入路神经内镜手术中的作用

Application of TCTI ratio in predicting tumor consistency in endoscopic endonasal transsphenoidal surgery for midline skull base meningiomas

目的探讨肿瘤与小脑脚MRI T_(2)加权成像信号强度(TCTI)比值预测肿瘤质地在颅底中线脑膜瘤经鼻蝶入路神经内镜手术(ETA)中的作用。方法回顾性分析2015年1月~2020年1月行ETA切除的20颅底中线脑膜瘤的临床资料。根据术前MRI T_(2)像,计算TCTI比值。以术中评估为准,判断肿瘤质地,分为质软和质韧。结果根据术中评估,肿瘤整体质韧6例(质韧组),肿瘤整体质软14例(质软组)。质韧组2例(33.3%)和质软组11例(79.0%)获得肿瘤全切除。质韧组术后发生并发症4例,质软组术后发生并发症4例。20例TCTI比值中位数为1.7(四分位间距1.3~2.4);质韧组TCTI比值中位数为1.6(四分位间距1.3~1.7),4例(66.7%)TCTI比值<1.6;质软组TCTI比值中位数为1.8(四分位间距1.3~2.4),13例(92.9%)TCTI比值≥1.6。TCTI比值≥1.6判断肿瘤质软的敏感性为80.0%,特异性为86.7%。术后随访6~37个月,中位数25.0个月;质韧组1例复发,TCTI比值为1.3。结论肿瘤质地与ETA切除颅底中线脑膜瘤的效果相关。术前TCTI比值可作为预测肿瘤质地的可靠指标,具有良好的敏感性和特异性。对于质韧的脑膜瘤,建议采用传统的经颅入路手术。

Objective To investigate the role of tumor to cerebellar peduncle T_(2)-weighted imaging intensity(TCTI)ratio in predicting tumor consistency in endoscopic endonasal transsphenoidal surgery(EETS)for midline skull base meningiomas.Methods The clinical data of 20 patients with midline skull base meningioma who underwent EETS from January 2015 to January 2020 were retrospectively analyzed.TCTI ratio was calculated according to the preoperative MRI T_(2) images.Based on the intraoperative evaluation,the tumor consistency was classified as soft consistency(soft group)and firm consistency(firm group).Results According to the intraoperative evaluation,6 tumors were generally firm(firm group)and 14 were soft(soft group).Total tumor resection was achieved in 2 patients(33.3%)in the firm group and 11(79.0%)in the soft group.Postoperative complications occurred in 4 patients in the firm group and in 4 patients in the soft group.The median preoperative TCTI ratio was 1.7[interquartile range(IR),1.3~2.4).The median TCTI ratio of the firm group was 1.6(IR,1.3~1.7),with a TCTI ratio<1.6 in 4 patients(66.7%).The median TCTI ratio in the soft group was 1.8(IR,1.3~2.4),with a TCTI ratio≥1.6 in 13 patients(92.9%).The sensitivity and specificity of TCTI ratio≥1.6 for predicting soft consistency were 80.0%and 86.7%,respectively.Postoperative follow-up(range,6~37 months;median,25.0 months)showed recurrence in 1 patient(TCTI ratio=1.3)of the firm group.Conclusions Tumor consistency is related to the outcomes of EETS for midline skull base meningiomas.The preoperative TCTI ratio can be used as a reliable indicator for predicting tumor consistency with good sensitivity and specificity.Traditional transcranial surgery is recommended for the midline skull base meningiomas with firm consistency.