Mantle R E, Lach B, Delgado M R, Baeesa S, Bélanger G
Department of Laboratory Medicine, Ottawa Hospital, University of Ottawa, Ontario, Canada.
J Neurosurg. 1999 Sep;91(3):375-83. doi: 10.3171/jns.1999.91.3.0375.
The goal of this study was to determine whether the quantity of peritumoral brain edema displayed on computerized tomography (CT) scanning could be correlated with brain invasion and subsequent recurrence of meningiomas.
One hundred thirty-five patients who underwent resection of intracranial meningiomas at the Ottawa Civic Hospital were followed during the period 1980 to 1998. A complete resection was defined as one in which tumor, invaded bone, and involved dura were removed. Tumors were examined microscopically for evidence of brain invasion. The mean follow-up period was 9 +/- 4 years (standard deviation [SD]) and the mean time to recurrence was 5 +/- 4 years (SD). The authors used a simple grading system based on the average thickness (in centimeters) of edema seen on an axial CT slice showing the most tumor. Edema grade was linearly related to edema volume determined by digitizing the scans (r = 0.96; 29 cases). The chance of brain invasion increased by 20% for each centimeter of edema (r(s) = 1, p < 0.0001; 124 cases). The presence of brain invasion was predictive of recurrence after complete resection with an accuracy of 83%, a sensitivity of 89%, and a specificity of 82%. The chance of recurrence within 10 years after complete resection was given by the equation: percentage chance of recurrence = (centimeter of edema)3 x 0.7, which can be used to predict the chance of recurrence based on findings on CT scans (r(s) = 1, p < 0.0001; 86 patients). Statistical significance was confirmed using Kaplan-Meier and univariate and multivariate analyses. Completeness of resection was the most powerful predictor of recurrence (p < 0.00001, r = 0.6), followed by edema grade and brain invasion (both p = 0.02, r = 0.1). Patient age and gender and tumor location, size, and histological subtype were nonsignificant factors.
Brain invasion causes peritumoral edema. Invaded brain tissue is also the source of residual cells in cases of tumor recurrence after gross-total resection.
本研究的目的是确定计算机断层扫描（CT）显示的肿瘤周围脑水肿量是否与脑膜瘤的脑侵犯及随后的复发相关。
1980年至1998年期间对在渥太华市民医院接受颅内脑膜瘤切除术的135例患者进行了随访。完全切除定义为切除肿瘤、受侵骨质和受累硬脑膜。对肿瘤进行显微镜检查以寻找脑侵犯的证据。平均随访期为9±4年（标准差[SD]），平均复发时间为5±4年（SD）。作者使用了一种简单的分级系统，该系统基于在显示最大肿瘤的轴向CT切片上看到的水肿平均厚度（以厘米为单位）。水肿分级与通过扫描数字化确定的水肿体积呈线性相关（r = 0.96；29例）。每增加1厘米水肿，脑侵犯的几率增加20%（r(s)=1，p<0.0001；124例）。脑侵犯的存在可预测完全切除后的复发，准确率为83%，敏感性为89%，特异性为82%。完全切除后10年内复发的几率由以下公式给出：复发几率百分比=(水肿厘米数)³×0.7，该公式可用于根据CT扫描结果预测复发几率（r(s)=1，p<0.0001；86例患者）。使用Kaplan-Meier法以及单因素和多因素分析确认了统计学意义。切除的完整性是复发的最有力预测因素（p<0.00001，r = 0.6），其次是水肿分级和脑侵犯（两者p = 0.02，r = 0.1）。患者年龄、性别以及肿瘤位置、大小和组织学亚型均为无显著意义的因素。
脑侵犯导致肿瘤周围水肿。在大体全切术后肿瘤复发的病例中，受侵脑组织也是残留细胞的来源。
