Haq Irwan Barlian Immadoel, Niantiarno Fajar Herbowo, Arifianto Muhammad Reza, Nagm Alhusain, Susilo Rahadian Indarto, Wahyuhadi Joni, Goto Takeo, Ohata Kenji
Department of Neurosurgery, Faculty of Medicine, Universitas Airlangga - Dr. Soetomo General Hospital, Surabaya, Indonesia.
Department of Neurosurgery, Graduate School of Medicine, Osaka University, Osaka, Japan.
Asian J Neurosurg. 2021 Feb 23;16(1):119-125. doi: 10.4103/ajns.AJNS_179_20. eCollection 2021 Jan-Mar.
As the most common intracranial extra-axial tumor among adults who tend to grow slowly with minimal clinical manifestation, the patients with meningioma could also fall in neurological emergency and even life-threatening status due to high intracranial pressure (ICP). In those circumstances, decompressive craniectomy (DC) without definitive tumor resection might offer an alternative treatment to alleviate acute increasing of ICP. The current report defines criteria for the indications of lifesaving DC for high ICP caused by deep-seated meningioma as an emergency management.
This study collected the candidates from 2012 to 2018 at Dr. Soetomo General Hospital, Surabaya, Indonesia. The sample included all meningioma patients who came to our ER who fulfilled the clinical (life-threatening decrease in Glasgow Coma Scale [GCS]) and radiography (deep-seated meningioma, midline shift in brain computed tomography [CT] >0.5 cm, and diameter of tumor >4 cm or tumor that involves the temporal lobe) criteria for emergency DC as a lifesaving procedure. GCS, midline shift, tumor diameter, and volume based on CT were evaluated before DC. Immediate postoperative GCS, time to tumor resection, and Glasgow Outcome Scale (GOS) were also assessed postoperation.
The study enrolled 14 patients, with an average preoperative GCS being 9.29 ± 1.38, whereas the mean midline shift was 15.84 ± 7.02 mm. The average of number of tumor's diameter and volume was 5.59 ± 1.44 cm and 66.76 ± 49.44 cc, respectively. Postoperation, the average time interval between DC and definitive tumor resection surgery was 5.07 ± 3.12 days. The average immediate of GCS postoperation was 10.07 ± 2.97, and the average GOS was 3.93 ± 1.27.
When emergency tumor resection could not be performed due to some limitation, as in developing countries, DC without tumor resection possibly offers lifesaving procedure in order to alleviate acute increasing ICP before the definitive surgical procedure is carried out. DC might also prevent a higher risk of morbidity and postoperative complications caused by peritumoral brain edema.
作为成人中最常见的颅内轴外肿瘤，脑膜瘤往往生长缓慢且临床表现轻微，但患者也可能因颅内压（ICP）升高而陷入神经急症甚至危及生命的状态。在这种情况下，不进行肿瘤根治性切除的减压颅骨切除术（DC）可能是缓解ICP急性升高的一种替代治疗方法。本报告定义了因深部脑膜瘤导致高ICP而行挽救生命的DC的适应症标准，作为一种紧急处理措施。
本研究收集了2012年至2018年印度尼西亚泗水苏托莫综合医院的患者。样本包括所有前来急诊室且符合临床（格拉斯哥昏迷量表[GCS]出现危及生命的下降）和影像学（深部脑膜瘤、脑计算机断层扫描[CT]中线移位>0.5 cm、肿瘤直径>4 cm或累及颞叶的肿瘤）标准的脑膜瘤患者，这些标准是作为挽救生命的紧急DC手术的依据。在进行DC之前，评估GCS、中线移位情况、肿瘤直径以及基于CT的肿瘤体积。术后还评估了即刻GCS、肿瘤切除时间以及格拉斯哥预后量表（GOS）。
该研究纳入了14例患者，术前平均GCS为9.29±1.38，而平均中线移位为15.84±7.02 mm。肿瘤直径和体积的平均值分别为5.59±1.44 cm和66.76±49.44 cc。术后，DC与肿瘤根治性切除手术之间的平均时间间隔为5.07±3.12天。术后即刻平均GCS为10.07±2.97，平均GOS为3.93±1.27。
在像发展中国家那样因某些限制无法进行急诊肿瘤切除时，不进行肿瘤切除的DC可能提供挽救生命的手术，以便在进行确定性手术之前缓解ICP的急性升高。DC还可能预防由肿瘤周围脑水肿引起的更高的发病风险和术后并发症。
