Department of Neurologic Surgery, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Department of Radiology, Mayo Clinic, Rochester, MN, USA.
Neurosurg Rev. 2020 Apr;43(2):525-535. doi: 10.1007/s10143-018-1026-1. Epub 2018 Aug 31.
Involvement of the superior sagittal sinus (SSS) by meningiomas poses specific challenges, without an agreement about the degree of surgical aggressiveness when dealing with these lesions. In this systematic review and meta-analysis, we compare outcomes and complication rates, after different surgical strategies. Studies focused on meningiomas involving the SSS were collected from numerous online databases. Surgical outcome and complication data were abstracted. Comparisons were made considering complication and recurrence rates between an "aggressive" and a "non-aggressive" surgical attitude. A total of 26 studies, encompassing 1614 patients, were identified. Most of the tumors (53%) arose from the middle third of SSS and 75% of patients had a patent sinus at the time of surgery. A favorable outcome was achieved in 73% of patients treated with an "aggressive" surgical attitude compared to 78% of patients treated with a "non-aggressive" surgical attitude. Complication rates were similar between "aggressive" and "non-aggressive" attitudes, except for a higher rate of venous infarct (4% versus 2%, respectively) and worsening of preexisting motor deficits (34% versus 13%, respectively) in aggressively treated patients. Recurrence rates were not substantially different in the two groups after accounting for length of follow-up. Patients with incomplete resection (Simpson grades II-V) or with high histological grade (WHO grade III) had significantly higher recurrence rates. A complete resection achieves higher rates of tumor control, however, without nullifying the risk of recurrence. Moreover, "aggressive" tumor removal is associated with higher rates of venous complications and worsening of preexisting motor deficits.
脑膜瘤累及上矢状窦（SSS）时会带来特殊的挑战，对于这些病变的手术侵袭性程度尚无共识。在这项系统评价和荟萃分析中，我们比较了不同手术策略的结果和并发症发生率。从多个在线数据库中收集了涉及 SSS 的脑膜瘤研究。提取了手术结果和并发症数据。比较了“积极”和“非积极”手术态度之间的并发症和复发率。共确定了 26 项研究，共纳入 1614 例患者。大多数肿瘤（53%）起源于 SSS 的中三分之一，75%的患者在手术时窦是通畅的。采用“积极”手术态度治疗的患者中，有 73%获得了良好的结果，而采用“非积极”手术态度治疗的患者中，这一比例为 78%。除了静脉梗死（分别为 4%和 2%）和已存在运动功能障碍恶化（分别为 34%和 13%）的发生率较高外，“积极”和“非积极”手术态度之间的并发症发生率相似。在考虑随访时间长短后，两组的复发率没有明显差异。不完全切除（Simpson 分级 II-V）或组织学分级较高（WHO 分级 III）的患者复发率明显较高。完全切除可提高肿瘤控制率，但不能消除复发风险。此外，“积极”肿瘤切除与更高的静脉并发症发生率和已存在运动功能障碍恶化相关。
