Rubin Giorgio, Herscovici Zvi, Laviv Yosef, Jackson Steve, Rappaport Zvi H
Department of Neurosurgery, Rabin Medical Center (Beilinson Campus), Petah Tikva, affiliated with Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
Isr Med Assoc J. 2011 Mar;13(3):157-60.
Nowadays meningiomas are frequently detected incidentally. Their natural history has not yet been established because it is difficult to predict the growth pattern. Therefore, the management, after the radiological diagnosis, is still controversial.
To evaluate the clinical outcome and growth rate of conservatively treated meningiomas at our tertiary center, identify prognostic factors of tumor growth, and suggest guidelines based on the available data and our experience.
We reviewed the clinical records of 56 patients with 63 untreated meningiomas. Most were diagniosed incidentally. Clinical features and imaging findings at diagnosis and during follow-up were compared between growing and non-growing tumors. Potential patient- and tumor-related predictive factors for growth were analyzed.
The study group included 46 women (52 meningiomas) and 10 men (11 meningiomas) aged 39-83 years. Mean tumor size was 18 +/- 11 mm (range 3-70 mm) at diagnosis and 22 +/- 11 mm (range 8-70 mm) at last follow-up; mean follow-up time was 65 +/- 34 months (range 15-152 months). During follow-up 24 tumors (38%) grew ata rate of 4 mm per year; none became symptomatic. Only two prognostic factors were statistically significantly associated with low growth rate: older age and tumor calcifications.
Given our finding of a low growth incidence of meningiomas in the elderly, we support conservative management in patients aged 70 years or older. Calcifications into the meningioma are also indicative of slow growth, suggesting a conservative strategy. Surgery is recommended in younger patients in whom tumor growth occurs more often and a longer follow-up is necessary.
如今，脑膜瘤常常是偶然被发现的。由于难以预测其生长模式，其自然病史尚未明确。因此，放射学诊断后的治疗方案仍存在争议。
评估在我们三级医疗中心接受保守治疗的脑膜瘤的临床结局和生长速率，确定肿瘤生长的预后因素，并根据现有数据和我们的经验提出指导原则。
我们回顾了56例患者63个未经治疗的脑膜瘤的临床记录。大多数是偶然诊断出来的。比较生长和未生长肿瘤在诊断时及随访期间的临床特征和影像学表现。分析与生长相关的潜在患者和肿瘤预测因素。
研究组包括46名女性（52个脑膜瘤）和10名男性（11个脑膜瘤），年龄在39 - 83岁之间。诊断时平均肿瘤大小为18±11毫米（范围3 - 70毫米），最后一次随访时为22±11毫米（范围8 - 70毫米）；平均随访时间为65±34个月（范围15 - 152个月）。随访期间，24个肿瘤（38%）以每年4毫米的速度生长；无一出现症状。只有两个预后因素与低生长速率有统计学显著相关性：年龄较大和肿瘤钙化。
鉴于我们发现老年脑膜瘤生长发生率较低，我们支持对70岁及以上患者进行保守治疗。脑膜瘤内的钙化也表明生长缓慢，提示采取保守策略。对于肿瘤生长更常见且需要更长随访时间的年轻患者，建议进行手术治疗。
