He Wenbo, Liu Zhiyong, Jie Danyang, Tang Liansha, Teng Haibo, Xu Jianguo
Department of Neurosurgery, West China Hospital of Sichuan University, Chengdu, China.
West China School of Medicine, Sichuan University, Chengdu, China.
Front Neurol. 2022 Jul 1;13:855973. doi: 10.3389/fneur.2022.855973. eCollection 2022.
The aim of this research was to summarize the clinical and prognostic features of the skull-base meningiomas with extracranial extensions, and enhance the management of skull-base communicative meningiomas.
We retrospectively studied the medical records and analyzed the follow-up information of 53 patients who have done surgery for skull-base meningiomas with extracranial extensions in West China Hospital of Sichuan University from 2009 to 2020.
The incidence of skull-base meningiomas with extracranial extensions was 0.74%. The average diagnosis age was 45.9 years, with a 1:3.1 men to women ratio. WHO grade I was seen in 84.9% of patients, and higher grades were found in 15.1%. Heterogeneous enhancement, high bone invasion rate, high incidence of peritumoral edema, and high dural tail sign rate were typical imaging features. Routine craniotomy and endoscopic endonasal approach were adopted, and gross total resection was performed in 62.3% of cases with 20.8% postoperative complication rates. The average follow-up time was 61.5 months, with a recurrence rate of 34.9%. By survival analysis, the extent of resection ( = 0.009) and the histological grade ( = 0.007) were significantly related to the prognosis. Adjuvant radiotherapy proved beneficial in patients with subtotal resection ( = 0.010) and high-grade meningiomas ( = 0.018).
Skull-base meningiomas with extracranial extensions were sporadic. According to the tumor location and communication way showed by the preoperative imaging, routine craniotomy or endoscopic endonasal approach with a reasonable skull-base repair strategy could be adopted to achieve the maximum tumor resection. Maximized resection, adjuvant radiotherapy, and low histological grade indicate a better prognosis.
本研究旨在总结颅底脑膜瘤伴颅外扩展的临床及预后特征，加强对颅底交通性脑膜瘤的管理。
我们回顾性研究了2009年至2020年在四川大学华西医院接受手术治疗的53例颅底脑膜瘤伴颅外扩展患者的病历，并分析了随访信息。
颅底脑膜瘤伴颅外扩展的发生率为0.74%。平均诊断年龄为45.9岁，男女比例为1:3.1。84.9%的患者为世界卫生组织I级，15.1%为更高等级。不均匀强化、高骨质侵犯率、瘤周水肿发生率高及硬脑膜尾征发生率高是典型的影像学特征。采用常规开颅手术和内镜鼻内入路，62.3%的病例实现了肿瘤全切除，术后并发症发生率为20.8%。平均随访时间为61.5个月，复发率为34.9%。通过生存分析，切除范围（P = 0.009）和组织学分级（P = 0.007）与预后显著相关。辅助放疗对次全切除患者（P = 0.010）和高级别脑膜瘤患者（P = 0.018）有益。
颅底脑膜瘤伴颅外扩展为散发性。根据术前影像学显示的肿瘤位置和交通方式，可采用常规开颅手术或内镜鼻内入路并结合合理的颅底修复策略，以实现最大程度的肿瘤切除。最大程度切除、辅助放疗及低组织学分级提示预后较好。
