Department of Neurosurgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Jiefang Avenue No. 1277, Wuhan, 430022, People's Republic of China.
Department of Neurosurgery, Suizhou Hospital, Hubei University of Medicine, Suizhou, 441300, Hubei, China.
Acta Neurochir (Wien). 2021 Jun;163(6):1677-1685. doi: 10.1007/s00701-021-04766-7. Epub 2021 Feb 20.
Total resection of meningiomas involving the major dural sinuses (MIMDS) is still challenging for neurosurgeons. Gamma knife radiosurgery (GKRS) was shown to have a high probability of tumor control. The current study evaluated the clinical outcomes of patients who underwent subtotal resection alone or in combination with postoperative GKRS for the treatment of WHO grade I MIMDS.
From January 2006 to December 2016, 204 patients with MIMDS underwent Simpson IV subtotal resection in Wuhan Union Hospital. In 151 patients, no additional treatment was performed, while the tumor remnant was treated with GKRS in 53 patients. All patients were monitored with regular MR follow-ups. We retrospectively reviewed the clinical data, radiological characteristics, and outcomes of these 204 patients. Progression-free survival (PFS) was determined by Kaplan-Meier analysis. Related factors were determined by univariate Cox regression analyses.
The mean follow-up period was 75.5 months. The tumor recurrence/progression rates were 13.9% in the microsurgery group and 3.8% in the combined therapy group (p = 0.045). The 5- and 10- year progression-free survival (PFS) rates were 92.3 and 80.7%, respectively, in the microsurgery group and 100.0 and 88.5% in the combined therapy group. Treatment approach was found to be an independent prognostic factor for tumor recurrence/progression in the univariable analyses (p=0.04).
Compared with microsurgery alone, targeted Simpson grade IV resection combined with early gamma knife treatment resulted in longer progression-free survival without increased complications for WHO grade I MIMDS.
对于神经外科医生来说，完全切除累及主要硬脑膜窦（MIMDS）的脑膜瘤仍然具有挑战性。伽玛刀放射外科手术（GKRS）已被证明具有较高的肿瘤控制概率。本研究评估了单独接受次全切除或联合术后 GKRS 治疗 WHO 分级 I MIMDS 的患者的临床结果。
从 2006 年 1 月至 2016 年 12 月，204 例 MIMDS 患者在武汉协和医院接受了 Simpson IV 次全切除术。在 151 例患者中，未进行额外治疗，而在 53 例患者中，肿瘤残余部分接受了 GKRS 治疗。所有患者均通过定期 MRI 随访进行监测。我们回顾性分析了这 204 例患者的临床资料、影像学特征和结果。无进展生存期（PFS）通过 Kaplan-Meier 分析确定。通过单因素 Cox 回归分析确定相关因素。
平均随访时间为 75.5 个月。手术组肿瘤复发/进展率为 13.9%，联合治疗组为 3.8%（p=0.045）。手术组的 5 年和 10 年无进展生存率（PFS）分别为 92.3%和 80.7%，联合治疗组分别为 100.0%和 88.5%。单变量分析发现，治疗方法是肿瘤复发/进展的独立预后因素（p=0.04）。
与单独手术相比，针对 WHO 分级 I MIMDS 的靶向 Simpson 四级切除联合早期伽玛刀治疗可延长无进展生存期，且不会增加并发症。
