Neurosurg Focus. 2018 Apr;44(4):E12. doi: 10.3171/2018.1.FOCUS17718.
OBJECTIVE Sphenoid wing meningiomas are a heterogeneous group of tumors with variable surgical risks and prognosis. Those that have grown to a very large size, encasing the major cerebral arteries, are associated with a high risk of stroke. In reviewing the authors' series of giant sphenoid wing meningiomas, the goal was to evaluate how the extent of the tumor's invasion of surrounding structures affected the ability to safely remove the tumor and restore function. METHODS The authors conducted a retrospective study of a series of giant sphenoid wing meningiomas operated on between 1996 and 2016. Inclusion criteria were meningiomas with a globoid component ≥ 6 cm, encasing at least 1 major intradural cerebral artery. Extent of resection was measured according to Simpson grade. RESULTS This series included 12 patients, with a mean age of 59 years. Visual symptoms were the most common clinical presentation. There was complete or partial encasement of all 3 major cerebral arteries except for 3 cases in which only the anterior cerebral artery was not involved. The lateral wall of the cavernous sinus was invaded in 8 cases (67%) and the optic canal in 6 (50%). Complete resection was achieved in 2 cases (Simpson grades 2 and 3). In the remaining 10 cases of partial resection (Simpson grade 4), radical removal (> 90%) was achieved in 7 cases (70%). In the immediate postoperative period, there were no deaths. Four of 9 patients with visual deficits improved, while the 5 others remained unchanged. Two patients experienced transient neurological deficits. Other than an asymptomatic lacuna of the internal capsule, there were no ischemic lesions following surgery. Tumor recurrence occurred in 5 patients, between 24 and 168 months (mean 61 months) following surgery. CONCLUSIONS Although these giant lesions encasing major cerebral arteries are particularly treacherous for surgery, this series demonstrates that it is possible to safely achieve radical removal and at times even gross-total resection. However, the risk of recurrence remains high and larger studies are needed to see if and how improvement can be achieved, whether in surgical technique or technological advances, and by determining the timing and modality of adjuvant radiation therapy.
目的
蝶骨翼脑膜瘤是一组具有不同手术风险和预后的异质性肿瘤。那些生长到非常大的尺寸,包裹主要大脑动脉的肿瘤,与中风的高风险相关。在回顾作者的一系列巨大蝶骨翼脑膜瘤系列中,目的是评估肿瘤对周围结构的侵袭程度如何影响安全切除肿瘤和恢复功能的能力。
方法
作者对 1996 年至 2016 年间手术治疗的一系列巨大蝶骨翼脑膜瘤进行了回顾性研究。纳入标准为具有球形成分≥6cm 的脑膜瘤,至少包裹 1 条主要颅内大脑动脉。根据 Simpson 分级测量切除程度。
结果
本系列包括 12 例患者,平均年龄 59 岁。视觉症状是最常见的临床表现。除 3 例仅前大脑动脉未受累外,所有 3 条主要大脑动脉均完全或部分包裹。8 例(67%)侵犯海绵窦外侧壁,6 例(50%)侵犯视神经管。2 例(Simpson 分级 2 和 3)实现完全切除。在其余 10 例部分切除(Simpson 分级 4)中,7 例(70%)实现根治性切除(>90%)。在术后即刻,无死亡。9 例视力减退患者中,4 例改善,其余 5 例无变化。2 例患者出现短暂性神经功能障碍。除术后无症状的内囊腔隙外,无缺血性病变。5 例患者术后复发,时间为 24-168 个月(平均 61 个月)。
结论
尽管这些包裹主要大脑动脉的巨大病变对手术特别危险,但本系列表明,安全地实现根治性切除,有时甚至是大体全切除是可能的。然而,复发风险仍然很高,需要更大的研究来确定是否以及如何通过确定辅助放射治疗的时机和方式,在手术技术或技术进步方面取得改善,并确定辅助放射治疗的时机和方式。