Tsuda Kyoji, Akutsu Hiroyoshi, Yamamoto Tetsuya, Nakai Kei, Ishikawa Eiichi, Matsumura Akira
Department of Neurosurgery, Graduate School of Comprehensive Human Sciences, University of Tsukuba.
Neurol Med Chir (Tokyo). 2014;54(11):907-13. doi: 10.2176/nmc.oa.2013-0311. Epub 2014 Apr 23.
It is generally accepted that the first choice of treatment for spinal meningiomas is "radical" surgical removal. However, Simpson grade I removal is sometimes difficult, especially in cases with ventral dural attachment, because of the risk of spinal cord damage or the difficulty of dural repair after radical resection. In addition, there is no consensus on a surgical strategy for radicality, whether or not Simpson grade I resection should be performed in all cases of spinal meningioma. In this study, we retrospectively analyzed clinical and radiological data of surgically treated 14 patients with spinal meningioma, to assess the influence of the Simpson grade to tumor recurrences during long-term follow-up (median 8.2 years, 1.3-27.9). The number of patients in Simpson grades I, II, III, and IV were 2, 8, 0, and 3, respectively; Simpson grading was not applicable to one patient with non-dura-based meningioma. No postoperative permanent neurological worsening was encountered. The recurrence rate was 21.4% (3 out of 14 cases). Of these 3 recurrent cases, 1 was a case of non-dura-based meningioma and another was a case of neurofibromatosis type 2 (NF2); both of them are known as risk factors for recurrence after surgical removal of spinal meningiomas. Considering this background of these two recurrences, the clinical results of the present study are consistent with previous results. Therefore, we propose that surgeons do not always have to achieve Simpson grade I removal if dural repair is complicated and postoperative cerebrospinal fluid (CSF) leakage or neurological worsening are estimated after resection of dural attachment and repair of dural defect.
一般认为，脊髓脑膜瘤的首选治疗方法是“根治性”手术切除。然而，辛普森一级切除有时很困难，特别是在硬脑膜腹侧附着的病例中，因为存在脊髓损伤的风险或根治性切除后硬脑膜修复的困难。此外，对于根治性的手术策略，即在所有脊髓脑膜瘤病例中是否都应进行辛普森一级切除，目前尚无共识。在本研究中，我们回顾性分析了14例接受手术治疗的脊髓脑膜瘤患者的临床和影像学资料，以评估辛普森分级对长期随访（中位8.2年，1.3 - 27.9年）期间肿瘤复发的影响。辛普森一级、二级、三级和四级的患者人数分别为2、8、0和3；辛普森分级不适用于1例非硬脑膜型脑膜瘤患者。未出现术后永久性神经功能恶化。复发率为21.4%（14例中有3例）。在这3例复发病例中，1例是非硬脑膜型脑膜瘤，另1例是2型神经纤维瘤病（NF2）；这两者均为脊髓脑膜瘤手术切除后复发的已知危险因素。考虑到这两例复发的背景情况，本研究的临床结果与先前结果一致。因此，我们建议，如果硬脑膜修复复杂且预计在切除硬脑膜附着和修复硬脑膜缺损后会出现术后脑脊液（CSF）漏或神经功能恶化，外科医生不必总是追求辛普森一级切除。
