Ehresman Jeff S, Garzon-Muvdi Tomas, Rogers Davis, Lim Michael, Gallia Gary L, Weingart Jon, Brem Henry, Bettegowda Chetan, Chaichana Kaisorn L
Department of Neurosurgery, Johns Hopkins University School of Medicine, Johns Hopkins University, Baltimore, Maryland, United States.
Department of Neurosurgery, Mayo Clinic Florida, Jacksonville, Florida, United States.
J Neurol Surg B Skull Base. 2019 Feb;80(1):59-66. doi: 10.1055/s-0038-1667066. Epub 2018 Jul 17.
Meningiomas occur in various intracranial locations. Each location is associated with a unique set of surgical nuances and risk profiles. The incidence and risk factors that predispose patients to certain deficits based on tumor locations are unclear. This study aimed to determine which preoperative factors increase the risk of patients having new deficits after surgery based on tumor location for patients undergoing intracranial meningioma surgery. Adult patients who underwent primary, nonbiopsy resection of a meningioma at a tertiary care institution between 2007 and 2015 were retrospectively reviewed. Stepwise multivariate logistic regression analyses were used to identify associations with postoperative deficits based on tumor location. Postoperatively, from the 761 included patients, there were 39 motor deficits (5.1%), 23 vision deficits (3.0%), 19 language deficits (2.5%), 27 seizures (3.5%), and 26 cognitive deficits (3.4%). The factors independently associated with any postoperative deficits were preoperative radiation (hazard ratio [HR] [95% confidence interval, CI] 3.000 [1.346-6.338], = 0.008), cerebellopontine angle tumors (HR [95% CI] 2.126 [1.094-3.947], = 0.03), Simpson grade 4 resections (HR [95% CI] 2.000 [1.271-3.127], = 0.003), preoperative motor deficits (HR [95% CI] 1.738 [1.005-2.923], = 0.048), preoperative cognitive deficits (HR [95% CI] 2.033 [1.144-3.504], = 0.02), and perioperative pulmonary embolisms (HR [95% CI] 11.741 [2.803-59.314], = 0.0009). Consideration of the factors associated with postoperative deficits in this study may help guide treatment strategies for patients with meningiomas.
脑膜瘤发生于颅内的不同部位。每个部位都有一套独特的手术细微差别和风险特征。基于肿瘤部位使患者易出现某些功能缺损的发病率和风险因素尚不清楚。本研究旨在确定哪些术前因素会增加接受颅内脑膜瘤手术患者术后基于肿瘤部位出现新功能缺损的风险。 对2007年至2015年期间在一家三级医疗机构接受原发性、非活检性脑膜瘤切除术的成年患者进行回顾性研究。采用逐步多因素逻辑回归分析来确定基于肿瘤部位与术后功能缺损的相关性。 术后,在纳入的761例患者中,有39例运动功能缺损(5.1%)、23例视力功能缺损(3.0%)、19例语言功能缺损(2.5%)、27例癫痫发作(3.5%)和26例认知功能缺损(3.4%)。与任何术后功能缺损独立相关的因素包括术前放疗(风险比[HR][95%置信区间,CI]3.000[1.346 - 6.338],P = 0.008)、桥小脑角肿瘤(HR[95%CI]2.126[1.094 - 3.947],P = 0.03)、辛普森4级切除术(HR[95%CI]2.000[1.271 - 3.127],P = 0.003)、术前运动功能缺损(HR[95%CI]1.738[1.005 - 2.923],P = 0.048)、术前认知功能缺损(HR[95%CI]2.033[1.144 - 3.504],P = 0.02)和围手术期肺栓塞(HR[95%CI]11.741[2.803 - 59.314],P = 0.0009)。 本研究中对与术后功能缺损相关因素的考量可能有助于指导脑膜瘤患者的治疗策略。