Pieper D R, Al-Mefty O, Hanada Y, Buechner D
Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock 72205-7199, USA.
Neurosurgery. 1999 Apr;44(4):742-6; discussion 746-7. doi: 10.1097/00006123-199904000-00028.
Hyperostosis associated with intracranial meningiomas is a well-described entity. The cause, management, and prognosis of these bony changes have long been a point of controversy. Some authors have postulated that hyperostotic changes are secondary to the formation of the tumor and do not constitute invasion of the tumor into the bone. Determining this point has direct implications in the treatment of these patients, especially regarding surgical considerations. To more thoroughly evaluate this question, a study correlating the morphology to the radiology is necessary.
In this study, 51 patients underwent resection for meningiomas involving the cranial base. Preoperative radiographic evaluation using magnetic resonance imaging and/or computed tomography was performed, and areas of hyperostosis were identified. During the resection of the tumor, biopsies from these hyperostotic regions were sent for histological evaluation regarding the presence or absence of tumor invasion of the bone.
Preoperative neuroradiological assessment identified 26 patients with radiographic evidence of hyperostosis. Histological examination of the resected bone showed tumor invasion in 35 patients, including the area of radiographically identified hyperostosis in 25 of the 26 patients. The floor of the middle fossa was a specific area of low sensitivity for preoperative assessment of associated hyperostosis.
These results indicate that hyperostosis associated with meningiomas involving the cranial base are caused by tumor invasion of the bone histologically.
颅内脑膜瘤相关的骨质增生是一种已被充分描述的病症。这些骨质改变的病因、治疗方法及预后长期以来一直存在争议。一些作者推测，骨质增生性改变是肿瘤形成的继发结果，并不构成肿瘤对骨的侵犯。明确这一点对这些患者的治疗具有直接影响，尤其是在手术考量方面。为了更全面地评估这个问题，有必要进行一项将形态学与放射学相关联的研究。
在本研究中，51例患者接受了颅底脑膜瘤切除术。术前采用磁共振成像和/或计算机断层扫描进行影像学评估，并确定骨质增生区域。在肿瘤切除过程中，从这些骨质增生区域获取活检组织，送去进行组织学评估，以确定是否存在肿瘤对骨的侵犯。
术前神经放射学评估发现26例患者有骨质增生的影像学证据。对切除骨的组织学检查显示，35例患者存在肿瘤侵犯，其中26例患者中有25例在影像学确定的骨质增生区域存在肿瘤侵犯。中颅窝底部是术前评估相关骨质增生敏感性较低的特定区域。
这些结果表明，颅底脑膜瘤相关的骨质增生在组织学上是由肿瘤对骨的侵犯所致。
