Morales F, Maillo A, Díaz-Alvarez A, Merino M, Muñoz-Herrera A, Hernández J, Santamarta D
Servicio de Neurocirugia. Hospital Universitario de Salamanca.
Neurocirugia (Astur). 2005 Dec;16(6):477-85.
The aim of this study was to build a preoperative predictive system which could provide reliable information about: 1 degrees which skull base meningiomas can be total or partially removed, and 2 degrees their surgical outcome.
Patient histories and imaging data were reviewed retrospectively from 85 consecutive skull base meningiomas patients who underwent surgery from 1990 and 2002. From the preoperative data, nine variables were selected for conventional statistical analysis as regards their relationship with: 1 degrees total vs partial tumor resection and 2 degrees with patients outcome according to the degree of tumour removal.
From the nine variables analysed only two had a statistical association with the type of tumour resection performed (total vs partial) and the patient outcome: 1) arteries encasement and 2) cranial nerves involvement. Upon correlating these two variables with the type of tumour resection performed (total vs partial) and with the Karnofsky'scale to evaluate patients surgical outcome, the following grading groups were identified: Grade I: skull base meningiomas which did not involve cranial nerves or artery or only encased one artery or one cranial nerve. In these cases the incidence of gross tumour resection was 98.3% (p< 0.0001) and the perspective to reach 70 points in the Karnofsky'scale was of 96.5% ( p=0.001). Grade II: skull base meningiomas which involved one cranial nerve and encased, at least, two main cerebral arteries. In these cases, the frequency of total resection, decreased to 83.3% (p<0.0001) and the probability to reach 70 points in the Karnofsky'scale was 70.6% (p=0.001). Grade III: skull base meningiomas which involved two or more cranial nerves and encased several arteries In this group, the frequency of a total resection was of 42.9% (p<0.0001) and the probability of reaching 70 points in the Karnofsky'scale was only 60% (p=0.001).
We propose a preoperative grading system for skull base meningiomas that helps predicting both whether total or partial tumor removal will be achieved during surgery and the immediate postsurgical outcome of the patient. In applying this predictive system we will be able to reduce surgical morbidity, to advance the possibility of a radiosurgical treatment and give a more precise information to the patients and their families about our surgical decision-making process.
本研究的目的是建立一个术前预测系统，该系统能够提供有关以下方面的可靠信息：1. 颅底脑膜瘤能够被全切或部分切除的程度；2. 其手术结果的程度。
回顾性分析了1990年至2002年期间连续接受手术的85例颅底脑膜瘤患者的病史和影像资料。从术前数据中选择了9个变量进行常规统计分析，以研究它们与以下方面的关系：1. 肿瘤全切与部分切除的程度；2. 根据肿瘤切除程度的患者预后。
在分析的9个变量中，只有2个与所进行的肿瘤切除类型（全切与部分切除）和患者预后有统计学关联：1）动脉包绕；2）颅神经受累。将这两个变量与所进行的肿瘤切除类型（全切与部分切除）以及用于评估患者手术结果的卡氏评分相关联后，确定了以下分级组：I级：不涉及颅神经或动脉，或仅包绕一条动脉或一条颅神经的颅底脑膜瘤。在这些病例中，肿瘤全切率为98.3%（p<0.0001），卡氏评分达到70分的可能性为96.5%（p=0.001）。II级：涉及一条颅神经并至少包绕两条主要脑动脉的颅底脑膜瘤。在这些病例中，全切频率降至83.3%（p<0.0001），卡氏评分达到70分的概率为70.6%（p=0.001）。III级：涉及两条或更多颅神经并包绕多条动脉的颅底脑膜瘤。在该组中，全切频率为42.9%（p<0.0001），卡氏评分达到70分的概率仅为60%（p=0.001）。
我们提出了一种颅底脑膜瘤术前分级系统，有助于预测手术中肿瘤是能全切还是部分切除以及患者术后的近期结果。应用这个预测系统，我们将能够降低手术并发症发生率，提高放射外科治疗的可能性，并向患者及其家属提供有关我们手术决策过程的更精确信息。
