Freeman Jacob L, Davern Monica S, Oushy Soliman, Sillau Stefan, Ormond D Ryan, Youssef A Samy, Lillehei Kevin O
Department of Neurosurgery, University of Colorado, Aurora, Colorado, USA.
Department of Pediatric Neurology, University of California San Francisco, San Francisco, California, USA.
World Neurosurg. 2017 Mar;99:369-380. doi: 10.1016/j.wneu.2016.12.063. Epub 2016 Dec 23.
To examine the efficacy of spheno-orbital meningioma (SOM) resection aimed at symptomatic improvement, rather than gross total resection, followed by radiation therapy for recurrence.
A retrospective review of all patients having undergone resection between 2000 and 2016 was performed. Demographics, operative details, postoperative outcomes, recurrence rates, and radiation treatment plans were analyzed. Statistical analysis was performed to assess for factors affecting recurrence (Fisher exact and Student t test), changes in exophthalmos index (EI) (Student t test), and progression-free survival (Kaplan-Meier and log rank).
Twenty-five patients were included; 92% of participants were women. Mean age was 51 years. World Health Organization grades were I (n = 21) and II (n = 4). Simpson grades were I (n = 14), II (n = 3), and IV (n = 8). Mean follow-up time was 44.8 months. Proptosis was significantly improved at the 3- to 6-month postoperative visit (mean ΔEI, 0.15; P < 0.05) and at last follow-up (mean ΔEI, 0.13; P < 0.05). Visual acuity was either improved or stable in 18 of 19 patients. There were 12 recurrences; mean time to recurrence was 21.8 months. Increased recurrence rate was significantly associated with younger age. Eight patients received fractionated radiation at time of recurrence. To date, all treated patients are progression free.
Among this cohort, surgery provided a lasting improvement in proptosis and improved or stabilized visual deficits. Surgery followed by radiation at recurrence provided excellent tumor control and lends credence to the growing body of literature demonstrating effective control of subtotally resected skull base meningiomas.
探讨以症状改善而非全切为目标的蝶骨嵴脑膜瘤（SOM）切除术联合放射治疗预防复发的疗效。
回顾性分析2000年至2016年间所有接受手术治疗的患者。分析患者的人口统计学资料、手术细节、术后结果、复发率及放射治疗方案。采用统计学分析评估影响复发的因素（Fisher精确检验和Student t检验）、眼球突出指数（EI）的变化（Student t检验）以及无进展生存期（Kaplan-Meier法和对数秩检验）。
纳入25例患者；92%为女性。平均年龄51岁。世界卫生组织分级为I级（n = 21）和II级（n = 4）。辛普森分级为I级（n = 14）、II级（n = 3）和IV级（n = 8）。平均随访时间44.8个月。术后3至6个月时眼球突出明显改善（平均ΔEI，0.15；P < 0.05），末次随访时亦有改善（平均ΔEI，0.13；P < 0.05）。19例患者中有18例视力改善或稳定。有12例复发；平均复发时间为21.8个月。复发率增加与年龄较小显著相关。8例患者复发时接受了分次放疗。迄今为止，所有接受治疗的患者均无疾病进展。
在该队列中，手术使眼球突出得到持久改善，视力缺损改善或稳定。术后复发时进行放疗可实现良好的肿瘤控制，这也为越来越多证明次全切除颅底脑膜瘤可有效控制的文献提供了依据。
