Department of Neurosurgery, Harborview Medical Center, University of Washington, Seattle, Washington, USA.
Department of Neurosurgery, Harborview Medical Center, University of Washington, Seattle, Washington, USA; Department of Neurosurgery, Chang Gung Memorial Hospital, Chiayi, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan.
World Neurosurg. 2019 May;125:e521-e536. doi: 10.1016/j.wneu.2019.01.128. Epub 2019 Feb 1.
Management of meningiomas with major dural venous sinus involvement is challenging. We present our case series and perspective on reconstruction of the sinuses.
Fifty-five patients underwent operations between 2005 and 2016 and the retrospective data were collected and analyzed.
The cohort was younger with a mean of 51.3 years (range, 19-72 years) predominantly involving the superior sagittal sinus (44 patients). Sinus involvement was classified into group 1 (<50% of sinus, n = 28), group 2 (50%-99%, n = 8), and group 3 (total occlusion, n = 19). Venous collateralization was present in 100% of group 2 and 3 and in 36% of group 1 occlusions. Sinus pericranii was seen in 22 patients. Gross total resection was achieved in 87.2%, and sinus reconstruction followed in 38 patients (24 by direct suture and 14 by a patch graft). Pathology showed 36 (65%) World Health Organization grade I, 18 (33%) grade II, and 1 (2%) grade III tumors. During the mean follow-up of 60 months (range, 1-132 months), sinus was patent (74%) or narrowed but patent (24%) in 98%; 2 recurrences (3.6%) were observed (at 24 and 120 months). The mean preoperative/postoperative Karnofsky Performance Status and Kaplan-Meier cumulative overall/recurrence-free survival were 84.2%/88.1% and 90.9%/80.1%, respectively.
These meningiomas present in a younger population, are more likely to be World Health Organization grade II or III, necessitating a more aggressive tumor resection strategy. Aggressive resection coupled with sinus reconstruction results in good long-term surgical outcome and low recurrence rates.
大型硬脑膜静脉窦受累脑膜瘤的治疗颇具挑战性。我们报告了一系列病例，并阐述了我们对窦重建的观点。
2005 年至 2016 年间，55 例患者接受了手术，收集并分析了回顾性数据。
该队列患者年龄较轻，平均年龄为 51.3 岁（19-72 岁），主要累及上矢状窦（44 例）。窦受累分为 3 组：1 组（窦受累＜50%，n=28）、2 组（窦受累 50%-99%，n=8）和 3 组（完全闭塞，n=19）。静脉侧支循环存在于 2 组和 3 组的 100%患者和 1 组闭塞的 36%患者中。22 例患者存在硬脑膜窦膨出。87.2%的患者达到大体全切除，38 例患者进行了窦重建（24 例行直接缝合，14 例行补片移植）。病理检查显示 36 例（65%）为世界卫生组织（WHO）1 级，18 例（33%）为 2 级，1 例（2%）为 3 级肿瘤。在平均 60 个月（1-132 个月）的随访中，98%的窦保持通畅（74%）或狭窄但通畅（24%）；2 例（3.6%）患者出现复发（分别在术后 24 个月和 120 个月）。术前/术后卡氏功能状态评分的平均值和 Kaplan-Meier 累积总生存率/无复发生存率分别为 84.2%/88.1%和 90.9%/80.1%。
这些脑膜瘤患者年龄较轻，更有可能为 WHO 2 级或 3 级，需要更积极的肿瘤切除策略。积极的肿瘤切除联合窦重建可获得良好的长期手术效果和低复发率。
