Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, China.
Chin Med J (Engl). 2010 Oct;123(20):2865-73.
Resection of petroclival meningioma (PCM) is difficult for neurosurgeons and usually brings poor performance status. In this study, we evaluated the possible risk factors for unfavorable clinical outcomes of surgical treatment of PCM, and tried to explore the optimal surgical strategies for better postoperative quality of life.
We recruited 57 patients (14 male, 43 female, mean age, 50.5 years) who underwent surgical resection of PCM in Huashan Hospital during 2002 - 2006. The primary outcomes including postoperative neurological deficits, modified Rankin scale (mRS) score and recurrence rate were evaluated, and all potential risk factors were assessed by the χ(2) test. Odds ratio and 95% confidence interval were calculated by univariate Logistic regression. The mean follow-up time was 34 months.
Gross total resection was achieved in 58% of patients. One patient died during the perioperative period because of intracranial hemorrhage. Sixty-seven percent of patients experienced new postoperative neurological deficits and 26% had a higher mRS score at follow-up assessment. Postoperative complications were observed in 24 patients. Within the follow-up period, radiographic recurrence occurred in 12.3% of patients at a mean follow-up of 42 months. Postoperative radiosurgery was administered to 19 patients who had residual tumors or recurrence and no further progression was found. Tumor adhesion, hypervascularity and engulfment of neurovascular structures were three risk factors for increased mRS score (P = 0.0002; P = 0.0051; P = 0.0009). Tumor adherence to adjacent structures clearly affected the extent of resection (P = 0.0029). The risk of postoperative cranial nerve deficits increased with tumor engulfment of neurovascular structures (P = 0.0004).
Intraoperatively defined tumor characteristics played a critical role in identifying postoperative functional status. An individual treatment strategy after careful preoperative evaluation could help improve quality of life.
岩斜脑膜瘤（PCM）的切除术对神经外科医生来说具有挑战性，通常会导致患者预后不良。本研究旨在评估影响 PCM 手术治疗后临床结局的可能危险因素，并探讨获得更好术后生活质量的最佳手术策略。
回顾性分析 2002 年至 2006 年在华山医院接受 PCM 手术治疗的 57 例患者（男 14 例，女 43 例；平均年龄 50.5 岁）的临床资料。主要评估术后神经功能缺损、改良 Rankin 量表（mRS）评分和复发率，采用 χ(2)检验评估所有潜在的危险因素。采用单因素 Logistic 回归分析计算优势比和 95%置信区间。平均随访时间为 34 个月。
58%的患者实现了大体全切除。1 例患者因围手术期颅内出血死亡。67%的患者术后出现新的神经功能缺损，26%的患者 mRS 评分在随访时升高。24 例患者术后出现并发症。在随访期间，12.3%的患者（平均随访时间为 42 个月）出现影像学复发。19 例患者因残留肿瘤或复发接受术后放射外科治疗，未发现肿瘤进展。肿瘤与邻近结构的黏附、血供丰富和包绕神经血管结构是 mRS 评分升高的 3 个危险因素（P = 0.0002；P = 0.0051；P = 0.0009）。肿瘤与邻近结构的黏附程度明显影响肿瘤的切除程度（P = 0.0029）。肿瘤包绕神经血管结构与术后颅神经功能缺损的风险增加有关（P = 0.0004）。
术中定义的肿瘤特征对识别术后功能状态具有重要作用。术前仔细评估后制定个体化治疗策略有助于提高生活质量。
