Cannizzaro Delia, Milani Davide, Zaed Ismail, Tropeano Maria Pia, Nicolosi Federico, Costa Francesco, Servadei Franco, Fornari Maurizio, D'Angelo Vincenzo, Cardia Andrea
Department of Neurosurgery, Humanitas Clinical and Research Center - IRCCS, Rozzano, Italy.
Department of Neurosurgery, Hospital "Casa Sollievo Della Sofferenza", San Giovanni Rotondo, Italy.
Front Surg. 2022 Mar 9;9:840271. doi: 10.3389/fsurg.2022.840271. eCollection 2022.
Tentorial meningiomas account for only 3-6% of all intracranial meningiomas. Among them, tentorial incisura (notch) location must be considered as a subgroup with specific surgical anatomy and indications, morbidity, and mortality. In this study, we propose an update on preoperative management in order to reduce postoperative deficits.
We retrospectively collected adult patients treated for incisural meningioma between January 1992 and December 2016 in two different neurosurgical departments. Demographic, clinical, and neuroradiological preoperative and postoperative data were analyzed. In the most recent subgroup of tumors, a preoperative digital simulation was performed to define a volumetric digital quantification of the tumor resection. A review of the pertinent literature has been also done.
We included 26 patients. The median age was 58.4 years. Onset neurological signs were cranial nerve deficit in 9 patients, hemiparesis in 7, gait disturbance in 3, and intracranial hypertension in 3 patients. Simpson grade I removal was achieved in 12 patients, II in 10, III in 3, and IV in 1 patient. An overall rate of 23% postoperative complications was observed. The average follow-up duration was 68.5 months. Residual tumor was reported in 8 patients. Five patients underwent gamma knife radiosurgery. In 34.6% of patients, the surgical approach was chosen with preoperative digital planning estimating the potential volume of postoperative residual tumor, the target for radiosurgical treatment.
A multidisciplinary approach to plan incisural meningiomas management is important. To lower postoperative morbidity and mortality, a careful preoperative case analysis is useful. A planned residual tumor, supported by preoperative simulation imaging, could be safely treated with radiosurgery.
小脑幕脑膜瘤仅占所有颅内脑膜瘤的3%-6%。其中，小脑幕切迹（缺口）部位的脑膜瘤必须被视为具有特定手术解剖结构、适应证、发病率和死亡率的一个亚组。在本研究中，我们提出一种术前管理的更新方法，以减少术后缺陷。
我们回顾性收集了1992年1月至2016年12月期间在两个不同神经外科接受幕切迹脑膜瘤治疗的成年患者。对术前和术后的人口统计学、临床及神经放射学数据进行分析。在最新的肿瘤亚组中，进行了术前数字模拟以确定肿瘤切除的体积数字量化。还对相关文献进行了综述。
我们纳入了26例患者。中位年龄为58.4岁。首发神经症状为9例患者出现颅神经缺损，7例出现偏瘫，3例出现步态障碍，3例出现颅内高压。12例患者实现了辛普森一级切除，10例为二级，3例为三级，1例为四级。观察到术后并发症的总体发生率为23%。平均随访时间为68.5个月。8例患者报告有残留肿瘤。5例患者接受了伽玛刀放射治疗。在34.6%的患者中，手术入路是根据术前数字规划选择的，该规划估计了术后残留肿瘤的潜在体积，即放射外科治疗的目标。
采用多学科方法规划幕切迹脑膜瘤的治疗很重要。为降低术后发病率和死亡率，仔细的术前病例分析是有用的。术前模拟成像支持下的计划性残留肿瘤可以通过放射外科安全治疗。
