Department of Neurosurgery, Hôpital Neurologique Pierre Wertheimer, 59 Boulevard Pinel, 69667, Hospices Civils de Lyon, Bron, France.
Claude Bernard University, Lyon 1, Lyon, France.
Neurosurg Rev. 2022 Aug;45(4):2797-2809. doi: 10.1007/s10143-022-01792-6. Epub 2022 Apr 29.
Brain invasion has not been recognized as a standalone criterion for atypical meningioma by the WHO classification until 2016. Since the 2007 edition suggested that meningiomas harboring brain invasion could be classified as grade 2, brain invasion study was progressively strengthened in our center, based on a strong collaboration between neurosurgeons and neuropathologists regarding sample orientation and examination. Practice changes were considered homogeneous enough in 2011. The aim of the present study was to evaluate the impact of gross practice change on the clinical and pathological characteristics of intracranial meningiomas classified as grade 2.The characteristics of consecutive patients with a grade 2 meningioma surgically managed before (1998-2005, n = 125, group A) and after (2011-2014, n = 166, group B) practices changed were retrospectively reviewed.Sociodemographical and clinical parameters were comparable in groups A and B, and the median age was 62 years in both groups (p = 0.18). The 5-year recurrence rates (23.2% vs 29.5%, p = 0.23) were similar. In group A, brain invasion was present in 48/125 (38.4%) cases and was more frequent than in group B (14/166, 8.4%, p < 0.001). In group A, 33 (26.4%) meningiomas were classified as grade 2 solely based on brain invasion (group A), and 92 harbored other grade 2 criteria (group A). Group A meningiomas had a similar median progression-free survival compared to groups A (68 vs 80 months, p = 0.24) and to A and B pooled together (n = 258, 68 vs 90 months, p = 0.42).An accurate assessment of brain invasion is mandatory as brain invasion is a strong predictor of meningioma progression.
直到 2016 年，世界卫生组织分类才将脑侵犯视为非典型脑膜瘤的独立标准。自 2007 年版建议脑膜瘤中存在脑侵犯可被归类为 2 级以来，基于神经外科医生和神经病理学家在样本定向和检查方面的密切合作，我们中心逐渐加强了脑侵犯的研究。2011 年，实践变化被认为足够同质。本研究旨在评估大体实践变化对被归类为 2 级的颅内脑膜瘤的临床和病理特征的影响。回顾性分析了在实践改变之前（1998-2005 年，n=125，A 组）和之后（2011-2014 年，n=166，B 组）手术治疗的连续 2 级脑膜瘤患者的特征。A 组和 B 组的社会人口学和临床参数相似，两组的中位年龄均为 62 岁（p=0.18）。5 年复发率（23.2%比 29.5%，p=0.23）相似。在 A 组中，125 例中有 48 例（38.4%）存在脑侵犯，明显多于 B 组（166 例中有 14 例，8.4%，p<0.001）。在 A 组中，有 33 例（26.4%）脑膜瘤仅基于脑侵犯被归类为 2 级（A 组），92 例脑膜瘤存在其他 2 级标准（A 组）。A 组脑膜瘤的无进展生存率与 A 组（68 个月比 80 个月，p=0.24）和 A 组和 B 组总和（n=258，68 个月比 90 个月，p=0.42）相似。准确评估脑侵犯是必要的，因为脑侵犯是脑膜瘤进展的强烈预测因子。
