Magill Stephen T, Rick Jonathan W, Chen William C, Haase David A, Raleigh David R, Aghi Manish K, Theodosopoulos Philip V, McDermott Michael W
Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.
Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.
World Neurosurg. 2018 Jun;114:e1266-e1274. doi: 10.1016/j.wneu.2018.03.194. Epub 2018 Apr 4.
Petrous face meningiomas (PFMs) are challenging tumors because of their proximity to the cranial nerves, brainstem, and critical vasculature. The objective of this study is to present surgical outcomes and support an anatomic classification for PFM based on clinical presentation.
A retrospective chart review was performed, and 51 PFMs were identified. Tumors were classified by location along the petrous face into anterior, middle, and posterior. Presentation and outcomes were analyzed with logistic regression.
The median follow-up was 31.6 months. Tumors were World Health Organization grade I (n = 50), with 1 World Health Organization grade II tumor. Location was anterior (22%), middle (14%), posterior (53%), and overlapping (12%). Median tumor diameter was 3.0 cm (range, 0.8-6.2 cm). Anterior location was associated with facial pain/numbness on presentation (P < 0.0001), middle location with hearing loss/vestibular dysfunction (P = 0.0035), and posterior with hydrocephalus (P = 0.0190), headache (P = 0.0039), and vertigo (P = 0.0265). Extent of resection was gross total (63%), near total (14%), and subtotal (25%). The observed radiographic recurrence rate was 15%. Mean progression-free survival after diagnosis was 9.1 years with 2-year, 5-year, and 10-year progression-free survival of 91.8%, 78.6%, and 62.9%, respectively. The complication rate was 27%. Age, location, and approach were not associated with complications.
PFMs present with distinct clinical syndromes based on their location along the petrous face: anterior with trigeminal symptoms, middle with auditory/vestibular symptoms, and posterior with symptoms of mass effect/hydrocephalous. Surgical resection is associated with excellent long-term survival and a low rate of recurrence, which can be managed with radiotherapy.
岩面部脑膜瘤（PFMs）因其靠近颅神经、脑干和重要血管，是具有挑战性的肿瘤。本研究的目的是呈现手术结果，并支持基于临床表现的PFMs解剖学分类。
进行回顾性病历审查，确定了51例PFMs。根据岩面部的位置将肿瘤分为前部、中部和后部。使用逻辑回归分析临床表现和结果。
中位随访时间为31.6个月。肿瘤为世界卫生组织I级（n = 50），1例世界卫生组织II级肿瘤。位置为前部（22%）、中部（14%）、后部（53%）和重叠（12%）。肿瘤中位直径为3.0 cm（范围0.8 - 6.2 cm）。前部位置与就诊时面部疼痛/麻木相关（P < 0.0001），中部位置与听力丧失/前庭功能障碍相关（P = 0.0035），后部与脑积水（P = 0.0190）、头痛（P = 0.0039）和眩晕（P = 0.0265）相关。切除范围为全切（63%）、近全切（14%）和次全切（25%）。观察到的影像学复发率为15%。诊断后的平均无进展生存期为9.1年，2年、5年和10年无进展生存率分别为91.8%、78.6%和62.9%。并发症发生率为27%。年龄、位置和手术入路与并发症无关。
PFMs根据其在岩面部的位置表现出不同的临床综合征：前部表现为三叉神经症状，中部表现为听觉/前庭症状，后部表现为占位效应/脑积水症状。手术切除与良好的长期生存率和低复发率相关，复发可通过放疗处理。
