Department of Neurosurgery, University Hospital, Albert-Schweitzer-Campus 1, Building A1, 48149, Münster, Germany.
Institute of Neuropathology, University Hospital, Münster, Germany.
Acta Neurochir (Wien). 2018 Sep;160(9):1801-1812. doi: 10.1007/s00701-018-3617-6. Epub 2018 Jul 5.
There have been major developments in diagnostic and surgical and non-surgical techniques used in the management of meningiomas over last three decades. We set out to describe these changes in a systematic manner.
Clinical and radiological data, surgical procedures, complications, and outcome of 817 patients who underwent surgery for primarily diagnosed meningioma between 1991 and 2015 were investigated.
Median age at diagnosis increased significantly from 56 to 59 years (p = .042), while tumor location and preoperative Karnofsky performance status did not change during the observation period. Availability of preoperative MRI increased, and rates of angiography and tumor embolization decreased (p < .001, each). Median duration of total, pre-, and postoperative stay was 13, 2, and 9 days, respectively, and decreased between 1991 and 2015 (p < .001, each). Median incision-suture time varied annually (p < .001) but without becoming clearly longer or shorter during the entire observation period. The use of intraoperative neuronavigation and neuromonitoring increased, while the rates of Simpson grade I and III surgeries decreased (p < .001). Rates of postoperative hemorrhage (p = .997), hydrocephalus (p = .632), and wound infection (p = .126) did not change, while the frequency of early postoperative neurological deficits decreased from 21% between 1991 and 1995 to 13% between 2011 and 2015 (p = .003). During the same time, the rate of surgeries for postoperative cerebrospinal fluid leakage slightly increased from 2 to 3% (p = .049). Within a median follow-up of 62 months, progression was observed in 114 individuals (14%). Progression-free interval did not significantly change during observation period (p > .05). Multivariate analyses confirmed the lack of correlation between year of surgery and tumor relapse (HR: 1.1, p > .05).
Preoperative diagnosis and surgery of meningiomas have been substantially evolved. Although early neurological outcome has improved, long-term prognosis remains unchanged.
在过去的三十年中，脑膜瘤的诊断和手术及非手术技术有了重大发展。我们旨在系统地描述这些变化。
对 1991 年至 2015 年间因原发性脑膜瘤接受手术的 817 例患者的临床和影像学资料、手术过程、并发症和结果进行了调查。
诊断时的中位年龄从 56 岁显著增加到 59 岁（p = 0.042），而肿瘤位置和术前卡诺夫斯基表现状态在观察期间没有变化。术前 MRI 的可用性增加，血管造影和肿瘤栓塞的比率下降（p < 0.001，各）。总住院时间、术前和术后的中位数分别为 13、2 和 9 天，且在 1991 年至 2015 年期间减少（p < 0.001，各）。切口缝线时间每年都有变化（p < 0.001），但在整个观察期间并没有明显变长或变短。术中神经导航和神经监测的使用增加，而 Simpson 分级 I 和 III 手术的比率下降（p < 0.001）。术后出血（p = 0.997）、脑积水（p = 0.632）和伤口感染（p = 0.126）的发生率没有变化，而术后早期神经功能缺损的频率从 1991 年至 1995 年的 21%下降到 2011 年至 2015 年的 13%（p = 0.003）。同时，术后脑脊液漏的手术率从 2%略有增加到 3%（p = 0.049）。在中位数为 62 个月的随访期间，有 114 人（14%）出现进展。在观察期间，无进展生存期没有显著变化（p > 0.05）。多变量分析证实手术年份与肿瘤复发之间没有相关性（HR：1.1，p > 0.05）。
脑膜瘤的术前诊断和手术已经有了很大的发展。尽管早期神经预后有所改善，但长期预后保持不变。
