Department of Neurosurgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahi-machi, Abeno-ku, Osaka 545-8585, Japan.
Department of Neurosurgery, Osaka City General Hospital, 2-13-22 Miyakojima-hondori, Miyakojima-ku, Osaka 531-0021, Japan.
J Clin Neurosci. 2020 Jul;77:168-174. doi: 10.1016/j.jocn.2020.04.113. Epub 2020 Apr 30.
The objective of this study was to more fully understand the optimal neurosurgical strategy for spinal benign meningiomas from a medium to long-term perspective. This retrospective study included a cohort of 35 patients with a diagnosis of spinal meningioma who were first operated at our institute over the past 10 years and followed-up for at least 2 years after surgery. The inclusion criterion for the study was the pathological diagnosis finally verified as benign meningioma of World Health Organization (WHO) grade 1. The average follow-up duration after surgery was 61.0 months. The location of the spinal meningioma was classified into ventral or dorsal type based on the operative video record and the preoperative MR images. The extent of resection of the spinal meningioma was carefully determined based on the Simpson grade. The average neurological condition was significantly improved at the final follow-up. Simpson grade I or II resection was achieved in 31 of 35 cases (88.6%). No Simpson grade I or II cases showed local recurrence during follow-up. Tumor recurrence was noted in 2 of 4 cases of Simpson grade IV resection. One case has been followed-up without any re-operation because of no neurological deterioration, and the other case underwent stereotactic radiosurgery. This study suggested that meticulous Simpson grade II resection of spinal benign meningiomas of WHO grade 1 may be good enough from a medium to long-term follow-up perspective, though longer follow-up is absolutely necessary.
本研究旨在从中长期角度更全面地了解脊髓良性脑膜瘤的最佳神经外科治疗策略。这项回顾性研究纳入了在过去 10 年内我院首次手术治疗的 35 例脊髓脑膜瘤患者，且术后随访时间至少 2 年。研究纳入标准为最终病理诊断为世界卫生组织（WHO）1 级良性脑膜瘤。术后平均随访时间为 61.0 个月。根据手术视频记录和术前磁共振成像，将脊髓脑膜瘤的位置分为腹侧或背侧型。根据 Simpson 分级仔细确定脊髓脑膜瘤的切除范围。最终随访时，平均神经状况明显改善。35 例中有 31 例（88.6%）达到 Simpson 分级 I 或 II 级切除。随访期间无 Simpson 分级 I 或 II 级病例出现局部复发。4 例 Simpson 分级 IV 切除病例中有 2 例出现肿瘤复发。1 例因无神经恶化而无需再次手术，另 1 例接受立体定向放射外科治疗。本研究表明，对于 WHO 1 级的脊髓良性脑膜瘤，从中长期随访的角度来看，细致的 Simpson 分级 II 切除可能已经足够，尽管需要更长时间的随访。
