School of Medicine, University of Liverpool, Brownlow Hill, Liverpool, L69 7ZX, UK.
The Walton Centre NHS Foundation Trust, Lower Lane, Fazakerley, L9 7LJ, Liverpool, UK.
Acta Neurochir (Wien). 2023 May;165(5):1355-1363. doi: 10.1007/s00701-023-05535-4. Epub 2023 Mar 6.
Intracranial meningioma with bone involvement and primary intraosseous meningioma is uncommon. There is currently no consensus for optimal management. This study aimed to describe the management strategy and outcomes for a 10-year illustrative cohort, and propose an algorithm to aid clinicians in selecting cranioplasty material in such patients.
A single-centre, retrospective cohort study (January 2010-August 2021). All adult patients requiring cranial reconstruction due to meningioma with bone involvement or primary intraosseous meningioma were included. Baseline patient and meningioma characteristics, surgical strategy, and surgical morbidity were examined. Descriptive statistics were performed using SPSS v24.0. Data visualisation was performed using R v4.1.0.
Thirty-three patients were identified (mean age 56 years; SD 15) There were 19 females. Twenty-nine patients had secondary bone involvement (88%). Four had primary intraosseous meningioma (12%). Nineteen had gross total resection (GTR; 58%). Thirty had primary 'on-table' cranioplasty (91%). Cranioplasty materials included pre-fabricated polymethyl methacrylate (pPMMA) (n = 12; 36%), titanium mesh (n = 10; 30%), hand-moulded polymethyl methacrylate cement (hPMMA) (n = 4; 12%), pre-fabricated titanium plate (n = 4; 12%), hydroxyapatite (n = 2; 6%), and a single case combining titanium mesh with hPMMA cement (n = 1; 3%). Five patients required reoperation for a postoperative complication (15%).
Meningioma with bone involvement and primary intraosseous meningioma often requires cranial reconstruction, but this may not be evident prior to surgical resection. Our experience demonstrates that a wide variety of materials have been used successfully, but that pre-fabricated materials may be associated with fewer postoperative complications. Further research within this population is warranted to identify the most appropriate operative strategy.
颅内脑膜瘤伴骨累及和原发性骨内脑膜瘤并不常见。目前对于最佳治疗方法尚无共识。本研究旨在描述一个 10 年的病例队列的治疗策略和结果，并提出一个算法，以帮助临床医生在这类患者中选择颅骨修复材料。
这是一项单中心回顾性队列研究（2010 年 1 月至 2021 年 8 月）。所有因脑膜瘤伴骨累及或原发性骨内脑膜瘤需要颅骨重建的成年患者均被纳入研究。分析了患者和脑膜瘤的基线特征、手术策略和手术并发症。使用 SPSS v24.0 进行描述性统计。使用 R v4.1.0 进行数据可视化。
共确定了 33 例患者（平均年龄 56 岁，标准差 15 岁），其中女性 19 例。29 例为继发性骨累及（88%），4 例为原发性骨内脑膜瘤（12%）。19 例为大体全切除（GTR；58%）。30 例在初次手术中进行了颅骨修复（91%）。颅骨修复材料包括预制聚甲基丙烯酸甲酯（pPMMA）（n=12；36%）、钛网（n=10；30%）、手工成型聚甲基丙烯酸甲酯水泥（hPMMA）（n=4；12%）、预制钛板（n=4；12%）、羟基磷灰石（n=2；6%），以及 1 例钛网与 hPMMA 水泥联合使用（n=1；3%）。5 例患者因术后并发症需要再次手术（15%）。
伴骨累及的脑膜瘤和原发性骨内脑膜瘤常需颅骨重建，但在手术切除前可能并不明显。我们的经验表明，多种材料已成功应用，但预制材料可能与较少的术后并发症相关。需要对这一人群进行进一步的研究，以确定最合适的手术策略。
