Department of Ophthalmology, Department of Psychiatry, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, Romania;
Rom J Morphol Embryol. 2020 Apr-Jun;61(2):385-395. doi: 10.47162/RJME.61.2.08.
Parasagittal and falcine meningiomas are still a challenge in terms of surgical resection. Although maximal safe resection is the main therapeutic approach, numerous postoperative complications can still occur depending on the locations of these tumors. Moreover, previous studies have reported that parasagittal meningiomas have a higher recurrence rate than meningiomas with other locations.
PATIENTS, MATERIALS AND METHODS: We retrospectively reviewed 21 patients with parasagittal and falcine atypical meningiomas [World Health Organization (WHO) grade II], nine of whom had their superior sagittal sinus (SSS) invaded by the tumor. We reviewed the demographic information, operative notes, pathological reports, and clinical and imagistic follow-up reports of each patient over a 5-year time span.
All the patients were surgically treated, and the tumor removal was grade II according to Simpson's grading system in 47.6% and grade III in 19% of the cases. The SSS was invaded in 42.9% of the patients. No immediate mortality or morbidity was revealed by our study. Tumor recurrence/progression documented on postoperative imaging amounted to 14.3% and 19%, 12 and 24 months after surgery, respectively. Furthermore, 36, 48 and 60 months after the surgery, the recurrence rate remained the same, namely in 9.5% of the cases. The recurrence was higher in patients with SSS invasion than in patients with no SSS invasion. The tumor recurrence was slightly more predominant in women, i.e., 6% higher than in the male group.
In our group of patients with parasagittal and falcine meningiomas, we report a 47.6% Simpson II resection rate and 19% Simpson III resection rate associated with a very low complication rate and no immediately postoperative morbidity and mortality, compared to more aggressive techniques. The recurrence of parasagittal meningiomas predominated after grade III and IV Simpson resection and dural sinus invasion was a negative predictive factor for recurrence. Therefore, the surgery of parasagittal and falcine meningiomas is beneficial, both for tumor control, but also for improving neurological outcome. Aggressive meningioma resection should be balanced with the increased neurosurgical risk.
矢状窦旁和镰旁脑膜瘤的手术切除仍然是一个挑战。尽管最大限度地安全切除是主要的治疗方法，但根据肿瘤的位置，仍会发生许多术后并发症。此外，先前的研究报告称，矢状窦旁脑膜瘤的复发率高于其他部位的脑膜瘤。
患者、材料和方法：我们回顾性分析了 21 例矢状窦旁和镰旁非典型脑膜瘤（世界卫生组织 [WHO] 二级）患者，其中 9 例肿瘤侵犯上矢状窦（SSS）。我们回顾了每位患者在 5 年时间跨度内的人口统计学信息、手术记录、病理报告以及临床和影像学随访报告。
所有患者均接受手术治疗，根据 Simpson 分级系统，肿瘤切除程度为 II 级的占 47.6%，III 级的占 19%。42.9%的患者 SSS 受侵犯。本研究未发现即刻死亡或发病率。术后影像学显示肿瘤复发/进展分别为 14.3%和 19%，术后 12 和 24 个月。此外，术后 36、48 和 60 个月，复发率保持不变，即分别为 9.5%。SSS 受侵犯患者的复发率高于未受侵犯患者。女性肿瘤复发率略高于男性，即比男性组高 6%。
在我们的矢状窦旁和镰旁脑膜瘤患者组中，与更激进的技术相比，我们报告的 Simpson II 级切除率为 47.6%，Simpson III 级切除率为 19%，并发症发生率非常低，且无术后即刻发病率和死亡率。矢状窦旁脑膜瘤的复发主要发生在 III 级和 IV 级 Simpson 切除后，硬膜窦侵犯是复发的阴性预测因素。因此，矢状窦旁和镰旁脑膜瘤的手术治疗不仅有利于肿瘤控制，还有助于改善神经功能预后。脑膜瘤的激进切除应与增加的神经外科风险相平衡。
