Mascarella Marco A, Tewfik Marc A, Aldosari Majed, Sirhan Denis, Zeitouni Anthony, Di Maio Salvatore
Department of Otolaryngology, Head and Neck Surgery, Royal Victoria Hospital, McGill University, Montreal, Quebec, Canada.
Department of Neurology and Neurosurgery, Montreal Neurological Hospital, McGill University, Montreal, Quebec, Canada.
World Neurosurg. 2016 Jul;91:582-591.e1. doi: 10.1016/j.wneu.2016.04.093. Epub 2016 May 3.
To identify clinico-radiologic factors associated with incomplete anterior cranial fossa (ACF) meningioma resection via an endoscopic endonasal approach.
Patients undergoing endoscopic endonasal resection of an ACF meningioma were retrospectively accrued from two university-affiliated centers. Demographic profiles and radiologic findings, including tumor dimensions and morphology, anatomic location, and vascular involvement, were stratified according to the extent of resection.
Twenty-five patients were included in this study. Factors associated with incomplete surgical resection via an endonasal route were: presence of hyperostosis (P = 0.04), cavernous internal carotid artery involvement (P = 0.001), maximal dural tail length in the transverse plane (P = 0.006), and its ratio to the inter-fovea ethmoidalis distance (P = 0.01). Using a multiple regression analysis, only cavernous internal carotid artery involvement (P = 0.002) and a large dural tail length to inter-foveal distance ratio (P = 0.04) were significant predictors of incomplete resection (multiple correlation coefficient = 0.71). The combination of predictive factors to determine the likelihood of complete endoscopic resection produced a scoring system with a sensitivity and specificity of 85.7% (95% confidence interval [CI], 42.1-99.6] and 100% (95% CI, 81.5-100), respectively.
The use of a simple scoring system outlined in our study can facilitate proper patient selection for endoscopic endonasal resection of ACF meningiomas.
确定经鼻内镜入路切除前颅窝（ACF）脑膜瘤不完全切除相关的临床放射学因素。
回顾性收集来自两个大学附属医院中心接受经鼻内镜切除ACF脑膜瘤的患者。根据切除范围对人口统计学资料和放射学表现进行分层，包括肿瘤大小和形态、解剖位置及血管受累情况。
本研究纳入25例患者。经鼻入路手术切除不完全相关的因素有：骨质增生的存在（P = 0.04）、海绵窦段颈内动脉受累（P = 0.001）、横断面上硬脑膜尾征的最大长度（P = 0.006）及其与筛窦间距离的比值（P = 0.01）。多元回归分析显示，仅海绵窦段颈内动脉受累（P = 0.002）和硬脑膜尾征长度与两眼间距离比值较大（P = 0.04）是不完全切除的显著预测因素（多元相关系数 = 0.71）。用于确定完全经鼻内镜切除可能性的预测因素组合产生了一个评分系统，其敏感性和特异性分别为85.7%（95%置信区间[CI]，42.1 - 99.6）和100%（95%CI，81.5 - 100）。
我们研究中概述的简单评分系统的应用有助于为ACF脑膜瘤经鼻内镜切除选择合适的患者。
