Hirschmann Dorian, Nasiri Danial, Entenmann Christian Joachim, Haberler Christine, Roetzer Thomas, Dorfer Christian, Millesi Matthias
Department of Neurosurgery, Medical University of Vienna, Vienna, Austria.
Department of Neurosurgery, Inselspital Bern, Bern, Switzerland.
Wien Klin Wochenschr. 2025 Jan;137(1-2):21-30. doi: 10.1007/s00508-024-02382-w. Epub 2024 May 31.
To identify factors for tumor relapse and poor outcome in patients with meningiomas in the first two decades of life.
All patients ≤ 21 years of age who underwent resection of a meningioma at the department of neurosurgery, Medical University of Vienna between 1989 and 2022 were included in this retrospective study. Clinical and radiological data were extracted from the medical records. Outcome and tumor relapse were analyzed for tumor location, histological findings and extent of resection.
In this study 18 patients were included, 6 meningiomas were located in the skull base, 5 in the convexity and 7 in other locations including intraventricular and spine (2 patients each), falx, intraparenchymal and optic nerve sheath. Most frequent symptoms were seizures and cranial nerve palsy. In total 56% of the meningiomas were World Health organization (WHO) grade 1, 39% grade 2 and 5% grade 3. Gross total resection was achieved in 67%. The overall relapse rate was 61% and 50% underwent repeat surgery. All patients with convexity meningiomas became seizure free and had a favorable outcome. Relapse and clinical outcome were independent of WHO grade among the whole cohort but the outcome significantly depended on the WHO grade when patients with skull base meningiomas were analyzed as a subgroup. The relapse rate was significantly higher in cases of skull base location (100% vs. 42%, p = 0.038) and after subtotal resection (100% vs. 42%, p = 0.038). Clinical outcome was also significantly worse and the rate of complications was higher in patients with skull base meningiomas.
Patients with convexity meningiomas in the first two decades of life have a good outcome due to high chance of gross total resection. Patients with skull base meningioma are at high risk of relapse and poor outcome, particularly those with WHO grades 2 and 3. Subtotal resection in patients with skull base location is probably the main reason for this difference.
确定20岁前患脑膜瘤患者肿瘤复发及预后不良的因素。
本回顾性研究纳入了1989年至2022年间在维也纳医科大学神经外科接受脑膜瘤切除术的所有年龄≤21岁的患者。从病历中提取临床和放射学数据。对肿瘤位置、组织学结果和切除范围进行了预后及肿瘤复发分析。
本研究纳入18例患者，6例脑膜瘤位于颅底，5例位于凸面，7例位于其他部位，包括脑室内和脊柱（各2例）、大脑镰、脑实质内和视神经鞘。最常见的症状是癫痫发作和脑神经麻痹。脑膜瘤中，56%为世界卫生组织（WHO）1级，39%为2级，5%为3级。67%实现了全切。总体复发率为61%，50%接受了再次手术。所有凸面脑膜瘤患者癫痫发作停止，预后良好。在整个队列中，复发和临床预后与WHO分级无关，但将颅底脑膜瘤患者作为亚组分析时，预后显著取决于WHO分级。颅底部位病例的复发率显著更高（100%对42%，p = 0.038），次全切除术后复发率也显著更高（100%对42%，p = 0.038）。颅底脑膜瘤患者的临床预后也显著更差，并发症发生率更高。
20岁前患凸面脑膜瘤的患者因全切机会高而预后良好。颅底脑膜瘤患者复发风险高且预后不良，尤其是WHO 2级和3级的患者。颅底部位患者次全切除可能是造成这种差异的主要原因。
