Kalfas Fotios, Scudieri Claudia
Department of Neurological Surgery, Galliera Hospitals, Genova, Italy.
Department of Neurosurgery and Gamma Knife Radiosurgery, IRCCS San Raffaele Scientific Institute, Vita-Salute University, Milan, Italy.
Asian J Neurosurg. 2019 Nov 25;14(4):1138-1143. doi: 10.4103/ajns.AJNS_245_18. eCollection 2019 Oct-Dec.
The management of parasagittal and falcine meningiomas centers around the relationship between the tumor and the venous anatomy of the superior sagittal sinus (SSS) and the bridging veins.
The present study aims to address neurosurgical outcomes in a cohort of patients with parasagittal and falcine meningiomas >2.0 cm in the largest diameter, in which a neurosurgical/multidisciplinary treatment was considered.
The clinical outcomes of patients undergoing neurosurgical management for parasagittal and falcine meningiomas at the authors' institution over a 15-year period were analyzed. Analysis was limited to those tumors (primary, residual, or recurrences) >2.0 cm in the largest diameter.
The authors identified 100 patients with parasagittal/falcine meningiomas >2.0 cm in their largest diameter, who underwent neurosurgical treatment at their institution between 1999 and 2013.
Tumor control was assessed using Kaplan-Meier analysis, and specific attention was paid to the relationship between the tumor and the SSS and its impact on tumor control and outcome.
There was no difference in rates of tumor control in patients who received subtotal resection for a WHO Grade I tumor, followed by close observation, compared with those undergoing gross-total resection, primarily because no cases were observed in which the tumor remnant in the SSS demonstrated interval growth on serial imaging studies. Of patients in this series, 13% experienced at least one neurological, medical, surgical, or radiosurgical complication, and the mortality was 0%.
These data provide a more judicious optimization of the expected outcome that can be obtained with treatment of these tumors, in which a combination of image guidance, advanced microsurgical techniques, and conformal radiation treatments is used.
矢状窦旁和大脑镰脑膜瘤的治疗重点在于肿瘤与上矢状窦（SSS）静脉解剖结构及桥静脉之间的关系。
本研究旨在探讨一组最大直径>2.0 cm的矢状窦旁和大脑镰脑膜瘤患者的神经外科治疗结果，这些患者接受了神经外科/多学科治疗。
分析了作者所在机构15年间接受矢状窦旁和大脑镰脑膜瘤神经外科治疗患者的临床结果。分析仅限于那些最大直径>2.0 cm的肿瘤（原发性、残留性或复发性）。
作者确定了100例最大直径>2.0 cm的矢状窦旁/大脑镰脑膜瘤患者，他们于1999年至2013年在其机构接受了神经外科治疗。
采用Kaplan-Meier分析评估肿瘤控制情况，并特别关注肿瘤与上矢状窦的关系及其对肿瘤控制和结局的影响。
对于WHO I级肿瘤，接受次全切除并密切观察的患者与接受全切除的患者相比，肿瘤控制率无差异，主要原因是在连续影像学研究中未观察到上矢状窦内肿瘤残余有间隔生长的病例。在该系列患者中，13%经历了至少一种神经、医疗、手术或放射外科并发症，死亡率为0%。
这些数据为治疗这些肿瘤所能获得的预期结果提供了更明智的优化，其中采用了图像引导、先进的显微外科技术和适形放射治疗相结合的方法。
