Department of Neurosurgery, University of Cairo, Cairo, Egypt.
Department of Neurosurgery, University of Cairo, Cairo, Egypt.
World Neurosurg. 2020 May;137:e373-e382. doi: 10.1016/j.wneu.2020.01.202. Epub 2020 Feb 4.
No data are available on incidence, surgical approaches, complications, and survival for patients with infratentorial meningiomas in developing countries. Predictors for surgical resection, recurrence, and complications were analyzed based on the surgical outcomes of patients with infratentorial meningiomas.
A total of 101 consecutive cases of infratentorial meningiomas operated on between April 2012 and April 2017 at our institute were reviewed retrospectively. The patients had a mean age of 55.1 ± 5 years, a female predominance of 62.3%, and the mean duration of follow-up duration was 44.2 ± 15.5 months.
The most common surgical approach was retrosigmoid (n = 51) followed by suboccipital (n = 36), subtemporal (n = 8), and far lateral (n = 6). The preoperative presentation showed that affected cranial nerve was the most common presenting symptom (47.5%) followed by weakness (24.8%) and affected vision (16.8%) followed by headache (8.9%) and gait disturbance (6.9%). The extent of resection was grade I (n = 63), grade II (n = 15)and grade III (n = 23) according to the Simpson grading. The complication rate was 56 cases (55.4%); the most common complication was cranial nerve palsy (42.6%), followed by weakness (31.7%), hydrocephalus (16.8%), chest infection (8.9%), ataxia (4%), deep venous thrombosis (4%), cerebrospinal fluid leak (3%) and meningitis and pulmonary embolism (both 1%).
The location, surgical approach, preoperative Karnofsky Performance Status, and peritumor edema were significantly associated with complications. Compared with developed countries, we had a higher complication rate (P < 0.001), lower recurrence rate (P = 0.15), and slightly lower total resection rate (P = 0.29). These findings might be attributed to the patient's late presentation to the tertiary center and poor technical resources.
发展中国家尚无关于幕下脑膜瘤的发病率、手术入路、并发症和生存率的数据。本研究基于幕下脑膜瘤患者的手术结果，分析了手术切除、复发和并发症的预测因素。
回顾性分析 2012 年 4 月至 2017 年 4 月在我院接受手术治疗的 101 例幕下脑膜瘤患者的临床资料。患者平均年龄为 55.1±5 岁，女性占 62.3%，平均随访时间为 44.2±15.5 个月。
最常见的手术入路是乙状窦后入路（n=51），其次是枕下入路（n=36）、颞下入路（n=8）和远外侧入路（n=6）。术前表现为受影响的颅神经为最常见的首发症状（47.5%），其次为无力（24.8%）和受影响的视力（16.8%），其次为头痛（8.9%）和步态障碍（6.9%）。根据 Simpson 分级，肿瘤全切除程度为Ⅰ级（n=63）、Ⅱ级（n=15）和Ⅲ级（n=23）。并发症发生率为 56 例（55.4%）；最常见的并发症是颅神经麻痹（42.6%），其次是无力（31.7%）、脑积水（16.8%）、胸部感染（8.9%）、共济失调（4%）、深静脉血栓形成（4%）、脑脊液漏（3%）和脑膜炎及肺栓塞（各 1%）。
位置、手术入路、术前 Karnofsky 表现状态和肿瘤周围水肿与并发症显著相关。与发达国家相比，我们的并发症发生率较高（P<0.001），复发率较低（P=0.15），全切除率略低（P=0.29）。这些发现可能归因于患者就诊于三级中心较晚和技术资源较差。
