Department of Neurosurgery, Tufts Medical Center, Boston, MA, USA.
Department of Neurosurgery, Yale School of Medicine, 15 York Street, LLCI 810, New Haven, CT, 06510, USA.
J Neurooncol. 2023 Apr;162(2):253-265. doi: 10.1007/s11060-023-04272-z. Epub 2023 Apr 3.
Surgical resection has long been the treatment of choice for meningiomas and is considered curative in many cases. Indeed, the extent of resection (EOR) remains a significant factor in determining disease recurrence and outcome optimization for patients undergoing surgery. Although the Simpson Grading Scale continues to be widely accepted as the measure of EOR and is used to predict symptomatic recurrence, its utility is under increasing scrutiny. The influence of surgery in the definitive management of meningioma is being re-appraised considering the rapid evolution of our understanding of the biology of meningioma.
Although historically considered "benign" lesions, meningioma natural history can vary greatly, behaving with unexpectedly high recurrence rates and growth which do not always behave in accordance with their WHO grade. Histologically confirmed WHO grade 1 tumors may demonstrate unexpected recurrence, malignant transformation, and aggressive behavior, underscoring the molecular complexity and heterogeneity.
As our understanding of the clinical predictive power of genomic and epigenomic factors matures, we here discuss the importance of surgical decision-making paradigms in the context of our rapidly evolving understanding of these molecular features.
手术切除一直是脑膜瘤的治疗选择，在许多情况下被认为是治愈性的。事实上，切除范围（EOR）仍然是决定手术患者疾病复发和结果优化的重要因素。尽管辛普森分级量表仍然被广泛接受为 EOR 的衡量标准，并用于预测症状性复发，但它的实用性正受到越来越多的质疑。考虑到我们对脑膜瘤生物学的理解迅速发展，手术在脑膜瘤的确定性治疗中的作用正在重新评估。
虽然脑膜瘤历史上被认为是“良性”病变，但其自然病史差异很大，其复发率和生长速度出乎意料地高，并不总是与其世界卫生组织（WHO）分级一致。组织学证实的 WHO 分级 1 肿瘤可能表现出意外复发、恶性转化和侵袭性行为，突出了分子的复杂性和异质性。
随着我们对基因组和表观基因组因素的临床预测能力的理解不断成熟，我们在这里讨论了在我们对这些分子特征的快速发展的理解的背景下，手术决策模式的重要性。
