Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Topeliuksenkatu 5, P.O. Box 266, Fin-00029-HUS, Helsinki, Finland.
Department of Neurosurgery, University Hospital Salzburg, Paracelsus Medical University, Salzburg, Austria.
Acta Neurochir (Wien). 2021 Mar;163(3):677-687. doi: 10.1007/s00701-020-04520-5. Epub 2020 Aug 9.
Outcome and treatment-associated morbidity analysis of trigone meningioma surgery.
We retrospectively assessed 27 neurosurgically treated patients (median age 63 years, range 15-84) between 1999 and 2019. The median preoperative Karnofsky Performance Scale (KPS) was 80 (range 20-100), and the majority (78%) suffered from tumour-specific symptoms. The most frequent symptoms were aphasia (n = 6), visual field deficits (n = 5), and increased intracranial pressure (n = 5). The median tumour volume was 11.2 cm (range 3.9-220.5). The most common approaches were the transtemporal (n = 17) and transparietal routes (n = 5).
At last follow-up (median follow-up 35 months, range 3-127), the median KPS was 90 (range 30-100); eleven (42%) patients had improved, nine (35%) were unchanged, six (23%) had worsened, and one was lost to follow-up. One year after surgery, 18/21 (86%) patients had retained an activity level similar or improved compared with preoperatively. No surgery-related mortality was recorded. Postoperative new neurological deficits were seen in 13 (48%) patients; eight suffered from permanent, most commonly motor deficits (n = 4), and five of transient deficits. Permanent new motor deficits improved in the majority of affected patients (3/4) over time. New deficits were more often seen for transtemporal (8/17) than transparietal approaches (1/5). Patients with postoperative permanent new deficits had a significantly worse KPS at last follow-up (p < 0.001).
The transtemporal and transparietal approaches provide good access, but the latter might provide for a better risk profile. Patients show favourable outcome, but there is a considerable risk for new neurological deficits. This must be taken into consideration for oligosymptomatic patients.
三角区脑膜瘤手术的结果和治疗相关发病率分析。
我们回顾性评估了 1999 年至 2019 年间接受神经外科治疗的 27 例患者（中位年龄 63 岁，范围 15-84 岁）。术前卡诺夫斯基表现量表（KPS）的中位数为 80（范围 20-100），大多数（78%）患者存在与肿瘤相关的症状。最常见的症状为失语症（n=6）、视野缺损（n=5）和颅内压增高（n=5）。肿瘤体积中位数为 11.2cm³（范围 3.9-220.5cm³）。最常见的入路为颞下入路（n=17）和顶下入路（n=5）。
末次随访（中位随访时间 35 个月，范围 3-127 个月）时，KPS 的中位数为 90（范围 30-100）；11 例（42%）患者改善，9 例（35%）无变化，6 例（23%）恶化，1 例失访。术后 1 年，21 例（86%）患者保留了与术前相似或改善的活动水平。无手术相关死亡。术后新发神经功能缺损见于 13 例（48%）患者；8 例为永久性神经功能缺损，最常见的为运动功能缺损（n=4），5 例为暂时性神经功能缺损。大多数受影响患者（3/4）的永久性新运动缺陷随时间推移得到改善。颞下入路（8/17）比顶下入路（1/5）更容易出现新的神经功能缺损。术后新发永久性神经功能缺损患者的末次随访时 KPS 明显较差（p<0.001）。
颞下入路和顶下入路均可提供良好的入路，但后者可能具有更好的风险特征。患者的预后良好，但存在新的神经功能缺损的风险。对于症状较少的患者，必须考虑到这一点。
