Masalha Waseem, Heiland Dieter Henrik, Steiert Christine, Krüger Marie T, Schnell Daniel, Heiland Pamela, Bissolo Marco, Grosu Anca-L, Schnell Oliver, Beck Jürgen, Grauvogel Jürgen
Department of Neurosurgery, Medical Centre-University of Freiburg, 79106 Freiburg, Germany.
Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany.
Cancers (Basel). 2022 Apr 28;14(9):2201. doi: 10.3390/cancers14092201.
Medial sphenoid wing meningiomas are among the three most common intracranial meningiomas. These tumors pose a challenge to neurosurgeons in terms of surgical treatment, as they may involve critical neurovascular structures and invade the cavernous sinus. In case of the latter, a complete resection may not be achievable. The purpose of this study was to investigate prognostic features affecting recurrence and progression-free survival (PFS) of medial sphenoid wing meningiomas involving the cavernous sinus, focusing on the contribution of surgery and postoperative radiotherapy.
A retrospective analysis was conducted of the database of our institution, and 105 cases of medial sphenoid wing meningioma with invasion of the cavernous sinus, which were treated between 1998 and 2019, were included. Surgical treatment only was performed in 64 cases, and surgical treatment plus postoperative radiotherapy was performed in 41 cases. Kaplan-Meier analysis was conducted to estimate median survival and PFS rates, and Cox regression analysis was applied to determine significant factors that were associated with each therapeutic modality.
The risk of recurrence was significantly reduced after near-total resection (NTR) (-value = 0.0011) compared to subtotal resection. Progression-free survival was also significantly prolonged after postoperative radiotherapy (-value = 0.0002).
Maximal safe resection and postoperative stereotactic radiotherapy significantly reduced the recurrence rate of medial sphenoid wing meningiomas with infiltration of the cavernous sinus.
蝶骨嵴内侧脑膜瘤是三种最常见的颅内脑膜瘤之一。这些肿瘤在手术治疗方面给神经外科医生带来了挑战，因为它们可能累及关键的神经血管结构并侵犯海绵窦。如果是后者，可能无法实现完全切除。本研究的目的是调查影响累及海绵窦的蝶骨嵴内侧脑膜瘤复发和无进展生存期（PFS）的预后特征，重点关注手术和术后放疗的作用。
对我们机构的数据库进行回顾性分析，纳入1998年至2019年间治疗的105例侵犯海绵窦的蝶骨嵴内侧脑膜瘤病例。仅手术治疗64例，手术治疗加术后放疗41例。采用Kaplan-Meier分析估计中位生存期和PFS率，并应用Cox回归分析确定与每种治疗方式相关的显著因素。
与次全切除相比，近全切除（NTR）后复发风险显著降低（P值 = 0.0011）。术后放疗后无进展生存期也显著延长（P值 = 0.0002）。
最大安全切除和术后立体定向放疗显著降低了累及海绵窦的蝶骨嵴内侧脑膜瘤的复发率。
