Natarajan Sabareesh K, Sekhar Laligam N, Schessel David, Morita Akio
Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.
Neurosurgery. 2007 Jun;60(6):965-79; discussion 979-81. doi: 10.1227/01.NEU.0000255472.52882.D6.
To evaluate patients' clinical outcome, survival, and performance status, at the long-term follow-up evaluation after aggressive microsurgical resection of petroclival meningiomas.
During a 13-year period (1991-2004), 150 patients underwent 207 operative procedures for resection of petroclival meningiomas. The tumor size was large in 79% of the patients, with a mean tumor diameter of 3.44 cm. Tumors extended into adjoining regions in 57% of the patients. Thirty patients (20%) previously underwent operation or irradiation. One hundred patients (66%) had a single operation, 43 patients (29%) had two operations, and seven patients (5%) had three operations. Gross tumor resection was accomplished in 48 patients (32%), subtotal resection in 65 patients (43%), and partial resection in 37 patients (25%). There were no operative deaths. Postoperative complications (cerebrospinal fluid leakage, quadriparesis, infections, cranial nerve palsies, etc.) were observed in 33 patients (22%). Postoperative radiation or radiosurgery was administered to 47 of the 102 patients who had residual tumors. The outcome and survival of patients were evaluated by questionnaires, telephone calls, and review of their recent radiological images.
At the conclusion of the study, 87 patients (58%) were alive with disease and 45 patients (30%) were alive without disease. The mean follow-up period was 102 months (range, 15-180 mo). Seven patients (5%; five of the subtotal and partially resected patients and two of the total resection patients) had recurrence; of these patients, two underwent repeat resection and four were treated with gamma knife radiosurgery. One of the patients died of tumor progression with no response to gamma knife radiosurgery. The recurrence-free survival rate was 100% at 3 years, 92.7% at 7 years, and 85% at 12 years; the progression-free survival rate was 96% at 3 years, 86.8% at 7 years, and 79.5% at 12 years. The Karnofsky Performance Scale score was 78 +/- 11 preoperatively, 76 +/- 11 at 1 year postoperatively, and 84 +/- 9 at the time of the latest follow-up evaluation. Common disabilities at the time of the follow-up evaluation included diplopia, loss of hearing, balance problems, and loss of sensation in the V1 and V2 cranial nerve distribution. Most patients developed coping mechanisms.
This series has the largest number of patients with the longest follow-up period, to our knowledge, reported in the literature to date. The excellent quality of life at the time of the long-term follow-up examination for these patients warrants aggressive but judicious tumor resection, with or without radiosurgical treatment of tumor remnants.
在对岩斜区脑膜瘤进行积极的显微手术切除后的长期随访评估中，评估患者的临床结局、生存率和功能状态。
在13年期间（1991 - 2004年），150例患者接受了207次岩斜区脑膜瘤切除术。79%的患者肿瘤体积较大，肿瘤平均直径为3.44厘米。57%的患者肿瘤延伸至相邻区域。30例患者（20%）先前接受过手术或放疗。100例患者（66%）接受了一次手术，43例患者（29%）接受了两次手术，7例患者（5%）接受了三次手术。48例患者（32%）实现了肿瘤全切，65例患者（43%）次全切，37例患者（25%）部分切除。无手术死亡病例。33例患者（22%）出现了术后并发症（脑脊液漏、四肢瘫痪、感染、脑神经麻痹等）。102例有残留肿瘤的患者中有47例接受了术后放疗或放射外科治疗。通过问卷调查、电话随访以及复查近期影像学图像来评估患者的结局和生存情况。
在研究结束时，87例患者（58%）带瘤存活，45例患者（30%）无瘤存活。平均随访期为102个月（范围15 - 180个月）。7例患者（5%；次全切和部分切除患者中的5例以及全切患者中的2例）出现复发；其中，2例接受了再次切除，4例接受了伽玛刀放射外科治疗。1例患者死于肿瘤进展，对伽玛刀放射外科治疗无反应。3年时无复发生存率为100%，7年时为92.7%，12年时为85%；3年时无进展生存率为96%，7年时为86.8%，12年时为79.5%。术前卡氏功能状态评分平均为78±11，术后1年为76±11，最近一次随访评估时为84±9。随访评估时常见的功能障碍包括复视、听力丧失、平衡问题以及V1和V2脑神经分布区域的感觉丧失。大多数患者形成了应对机制。
据我们所知，该系列是迄今为止文献报道中患者数量最多、随访期最长的。这些患者长期随访检查时的良好生活质量证明，无论是否对肿瘤残余进行放射外科治疗，都有必要积极且审慎地进行肿瘤切除。
