Itamura Kyohei, Chang Ki-Eun, Lucas Joshua, Donoho Daniel A, Giannotta Steven, Zada Gabriel
J Neurosurg. 2018 Dec 14;131(5):1356-1360. doi: 10.3171/2018.7.JNS1838. Print 2019 Nov 1.
The present study aims to assess the clinical utility of a previously validated intraoperative meningioma consistency grading scale and its association with extent of resection (EOR) and various surgical outcomes.
The previously validated grading system was prospectively assessed in 127 consecutive patients undergoing open craniotomy for meningioma by multiple neurosurgeons at two high-volume academic hospitals from 2013 to 2016. Consistency grading scores ranging from 1 (soft) to 5 (firm/calcified) were retrospectively analyzed to test for association with surgical outcomes and EOR, categorized as gross-total resection (GTR) or subtotal resection, defined by postoperative MRI.
One hundred twenty-seven patients were included in the analysis with a tumor consistency distribution as follows: grade 1, 3.1%; grade 2, 14.2%; grade 3, 44.1%; grade 4, 32.3%; and grade 5, 6.3%. The mean tumor diameter was 3.6 ± 1.7 cm. Tumor consistency grades were grouped into soft (grades 1 and 2), average (grade 3), and firm (grades 4 and 5) groups for statistical analysis with distributions of 17.3%, 44.1%, and 38.6%, respectively. There was no association between meningioma consistency and maximal tumor diameter, or location. Mean duration of surgery was longer for tumors with higher consistency: grades 1 and 2, 186 minutes; grade 3, 219 minutes; and grades 4 and 5, 299 minutes (p = 0.000028). There was a trend toward higher perioperative complication rates for tumors of increased consistency: grades 1 and 2, 4.5%; grade 3, 7.0%; and grades 4 and 5, 20.8% (p = 0.047). The proportion of GTR for each consistency group was as follows: grades 1 and 2, 77%; grade 3, 68%; and grades 4 and 5, 43% (p = 0.0062).
In addition to other important meningioma characteristics such as invasiveness, tumor consistency is a key determinant of surgical outcomes, including operative duration and EOR. Future studies predicting tumor consistency based on preoperative neuroimaging will help considerably with preoperative planning for meningiomas.
本研究旨在评估一种先前验证的术中脑膜瘤质地分级量表的临床实用性及其与切除范围（EOR）和各种手术结果的关联。
2013年至2016年期间，两所大型学术医院的多名神经外科医生对127例连续接受开颅手术治疗脑膜瘤的患者进行了前瞻性评估，采用先前验证的分级系统。回顾性分析质地分级评分（范围为1级（软）至5级（硬/钙化）），以检测其与手术结果和EOR的关联，EOR分为全切除（GTR）或次全切除，根据术后MRI定义。
127例患者纳入分析，肿瘤质地分布如下：1级，3.1%；2级，14.2%；3级，44.1%；4级，32.3%；5级，6.3%。平均肿瘤直径为3.6±1.7 cm。为进行统计分析，将肿瘤质地分级分为软质组（1级和2级）、中等质地组（3级）和硬质组（4级和5级），分布分别为17.3%、44.1%和38.6%。脑膜瘤质地与最大肿瘤直径或位置之间无关联。质地较高的肿瘤手术平均持续时间更长：1级和2级为186分钟；3级为219分钟；4级和5级为299分钟（p = 0.000028）。质地增加的肿瘤围手术期并发症发生率有升高趋势：1级和2级为4.5%；3级为7.0%；4级和5级为20.8%（p = 0.047）。各质地组的GTR比例如下：1级和2级为77%；3级为68%；4级和5级为43%（p = 0.0062）。
除了侵袭性等其他重要的脑膜瘤特征外，肿瘤质地是手术结果（包括手术持续时间和EOR）的关键决定因素。未来基于术前神经影像学预测肿瘤质地的研究将极大地有助于脑膜瘤的术前规划。
