Boston Medical Center, Department of Neurosurgery, 725 Albany Street 7c, Boston, MA, 02118, USA.
Boston University School of Medicine, 72 East Concord Street, Boston, MA, 02118, USA.
Clin Neurol Neurosurg. 2020 Dec;199:106283. doi: 10.1016/j.clineuro.2020.106283. Epub 2020 Oct 6.
Primary intraosseous meningiomas (PIM) of calvarial origin are a small subset of meningiomas that arise from and occur within the calvarial bone. Its definition is often confused with other forms of non-dural based intracranial meningiomas, which has made previously published retrospective reviews heterogenous, non-specific and sometimes inaccurate. We present a systematic review of calvarial PIM.
Using a systematic search protocol that included databases such as PubMed, Web of Science and Embase, we extracted all human studies on PIM published from inception to December 2017. This systematic review includes case reports and retrospective reviews that specifically described PIM.
On review of 166 articles identified with the systematic search protocol, 69 articles were analyzed. These comprised of 64 case reports, 1 case series and 4 retrospective reviews. 111 patients with PIM of calvarial origin were analyzed, 58 % of which were females and 42 % males. The mean patient age was 51 years and the frontal bone was the most common tumor location, occurring in 26.1 % of the cases. Surgical resection was the predominant modality of treatment in 97.2 % of the cases, and gross total resection was achieved in 84 % of cases that reported extent of resection. There were no recurrences for grade I meningiomas. However, all grade III meningiomas recurred and 33.3 % of grade II meningiomas showed recurrence with a mean postoperative follow-up interval of 20 months. Statistical analysis using Fisher's exact test showed the recurrence rate to be strongly associated with WHO tumor grade (p-value <0.001).
There is statistically significant increased recurrence rate for calvarial PIM of higher grades, and we recommend close follow-up in those cases. Surgical resection remains the overwhelming treatment of choice for calvarial PIM, and it has a high gross total resection rate and low risk of complications and mortality.
颅盖原发性骨膜脑膜瘤（PIM）是脑膜瘤的一个小亚组，起源于颅骨内并发生在颅骨内。它的定义常常与其他形式的非硬脑膜颅内脑膜瘤相混淆，这使得以前发表的回顾性研究变得混杂、不具体，有时甚至不准确。我们对颅盖 PIM 进行了系统回顾。
使用包括 PubMed、Web of Science 和 Embase 在内的系统搜索方案，我们提取了从成立到 2017 年 12 月发表的所有关于 PIM 的人类研究。本系统回顾包括专门描述 PIM 的病例报告和回顾性研究。
通过系统搜索方案共检索到 166 篇文章，对其中 69 篇进行了分析。这些包括 64 份病例报告、1 份病例系列和 4 份回顾性研究。分析了 111 例颅盖 PIM 患者，其中 58%为女性，42%为男性。患者平均年龄为 51 岁，额骨是最常见的肿瘤部位，占 26.1%。97.2%的病例采用手术切除作为主要治疗方式，84%的病例报告了切除程度，其中 84%的病例达到了大体全切除。I 级脑膜瘤无复发。然而，所有 III 级脑膜瘤均复发，84%的 II 级脑膜瘤复发，平均术后随访时间为 20 个月。Fisher 精确检验的统计学分析表明，复发率与 WHO 肿瘤分级密切相关（p 值<0.001）。
高级别颅盖 PIM 的复发率显著增加，我们建议对此类病例进行密切随访。手术切除仍然是颅盖 PIM 的首选治疗方法，其大体全切除率高，并发症和死亡率低。
