Chen Rebecca, Aghi Manish K
Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, United States.
Department of Neurological Surgery, University of California San Francisco, San Francisco, CA, United States.
Handb Clin Neurol. 2020;170:233-244. doi: 10.1016/B978-0-12-822198-3.00043-4.
Meningiomas are the most common primary CNS tumor in adults, representing a third of brain lesions. Their clinical presentation varies greatly, ranging from asymptomatic incidental tumor to fatal tumor. The majority of meningiomas are benign, and gross total resection can achieve very low recurrence rates, with radiation therapy or radiosurgery reserved for recurrences or residual tumor that grows during serial imaging. At the other end of the spectrum, malignant meningiomas, although comprising just 1% of meningiomas, have been recognized to exhibit aggressive behavior that ultimately proves lethal regardless of the extent of resection or whether adjuvant radiation and chemotherapy are utilized. Over the past 2 decades, there has been pathologic recognition of a third type of meningioma known as "atypical," with borderline histologic and clinical features between benign and malignant meningioma. Here we review the clinical features, treatment, and outcomes of atypical meningiomas, with a focus on the impact of extent of resection and radiation therapy on the long-term recurrence rate of completely and incompletely resected atypical meningiomas.
脑膜瘤是成人最常见的原发性中枢神经系统肿瘤，占脑肿瘤的三分之一。其临床表现差异很大，从无症状的偶然肿瘤到致命肿瘤。大多数脑膜瘤是良性的，全切可实现极低的复发率，放疗或放射外科用于复发或在系列影像学检查中生长的残留肿瘤。另一方面，恶性脑膜瘤虽然仅占脑膜瘤的1%，但已被认为具有侵袭性，无论切除范围如何或是否使用辅助放疗和化疗，最终都会致命。在过去20年中，病理上认识到第三种类型的脑膜瘤，即“非典型”脑膜瘤，其组织学和临床特征介于良性和恶性脑膜瘤之间。在此，我们回顾非典型脑膜瘤的临床特征、治疗和结果，重点关注切除范围和放疗对完全和不完全切除的非典型脑膜瘤长期复发率的影响。
