Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA, 94305, USA.
Department of Neurosurgery, Massachusetts General Hospital, Boston, MA, USA.
J Neurooncol. 2021 Jun;153(2):331-342. doi: 10.1007/s11060-021-03773-z. Epub 2021 May 10.
Foramen magnum meningiomas (FMMs) are a major surgical challenge, due to relevant surgical morbidity and mortality. The paper aims to review the clinical (symptomatic improvement, complication rate, length of hospital stay) and radiological outcome (completeness of resection) of microsurgical resection of FMMs, and to identify predictors of complications.
A multi-institutional retrospective review of prospectively maintained database of FMMs included 51 patients (74.5% females) with a median tumor volume of 8.18 cm (range, 1.77-57.9 cm) and median follow-up of 36 months (range, 0.30-180.0 months). Tumors were resected though suboccipital approach (58.8%) or posterior-lateral approaches (39.3%), including far-lateral, extreme lateral and transcondylar approaches.
Gross-total resection (GTR) was achieved in 80.4% and 98% of cases did not present tumor regrowth or recurrence. Clinical symptoms improved in 34 patients (66.7%) and worsened in 5 (9.8%). The median length of hospital stay was 5 days. Mortality was null. Postoperative complications developed in 15 patients (29.4%), with cerebrospinal fluid leak (7.8%) and lower cranial nerves deficits (7.8%) as the most frequent. Craniospinal location (p = 0.03), location anterior to the dentate ligament (DL) (p = 0.02), involvement of vertebral artery (VA) (p = 0.03) were significantly associated with complication rate. These three elements allow calculating the Foramen Magnum Meningioma Risk Score (FRMMRS), to estimate the risk of post-operative complications.
Microsurgical resection allows for high GTR rate and low rate of tumor regrowth or recurrence, despite complications in one third of the patients. The FMMRS allows classifying FMMs and estimating the risk of post-operative complications.
枕骨大孔脑膜瘤（FMMS）是一项重大的手术挑战，因为相关的手术发病率和死亡率很高。本文旨在回顾 FMMS 的显微切除的临床（症状改善、并发症发生率、住院时间）和影像学结果（切除的完整性），并确定并发症的预测因素。
通过对前瞻性维护的 FMMS 数据库进行多机构回顾性分析，纳入了 51 例（74.5%为女性）患者，肿瘤体积中位数为 8.18cm（范围为 1.77-57.9cm），中位随访时间为 36 个月（范围为 0.30-180.0 个月）。肿瘤通过枕下入路（58.8%）或后外侧入路（39.3%）切除，包括远外侧、极外侧和经髁突入路。
GTR 率为 80.4%，98%的病例未出现肿瘤复发或残留。34 例患者（66.7%）的临床症状改善，5 例（9.8%）恶化。中位住院时间为 5 天。无死亡病例。15 例患者（29.4%）出现术后并发症，以脑脊液漏（7.8%）和颅神经损伤（7.8%）最常见。颅颈交界区（p=0.03）、位于齿状韧带（DL）前（p=0.02）、椎动脉（VA）受累（p=0.03）与并发症发生率显著相关。这三个因素可以计算出枕骨大孔脑膜瘤风险评分（FRMMRS），以估计术后并发症的风险。
尽管三分之一的患者出现并发症，但显微切除可以实现高 GTR 率和低肿瘤复发或残留率。FMMS 可以对 FRMMRS 进行分类，并估计术后并发症的风险。
