Department of Neurosurgery, West China Hospital, No. 37, Guoxue Alley, Chengdu, Sichuan, 610041, China.
West China School of Medicine, Sichuan University, Chengdu, Sichuan, China.
Neurosurg Rev. 2024 Oct 25;47(1):822. doi: 10.1007/s10143-024-03069-6.
The purpose of this research was to summarize the clinical and prognostic features of pineal region meningiomas, evaluate treatment strategies and long-term prognoses, and improve the management of pineal region meningiomas. We retrospectively studied the data of 37 patients who received surgical resection for pineal region meningiomas at West China Hospital of Sichuan University from 2009 to 2021. Adjuvant gamma knife radiosurgery (GKRS) was conducted according to the extent of resection (EOR). Progression-free survival (PFS), Karnofsky performance status (KPS) scores and recovery of neurological function were adopted to assess a comprehensive management strategy for pineal region meningiomas. The most common symptom was headache associated with intracranial hypertension (75.7%). The occipital transtentorial approach (40.5%) and supracerebellar infratentorial approach (29.7%) were performed in most cases. Gross total resection (GTR) was achieved in 27 patients (73.0%) and the remaining patients were treated with subtotal resection (STR) combined with postoperative GKRS. With a mean follow-up period of 87.0 months, the progression rate was 10.0%, the 5-year PFS rate was 92.9%, and the ΔKPS was 16.3. Multivariate analysis revealed that the STR + GKRS and supracerebellar infratentorial approach were beneficial to the recovery of quality of life of patients. Pineal region meningiomas are sporadic but challenging. It is necessary to select the most appropriate surgical approach, EOR, and hydrocephalus treatment strategy for patients with pineal region meningiomas. Maximal safe resection to protect neurovascular function combined with postoperative GKRS can significantly improve the quality of life of patients.
本研究旨在总结松果体区脑膜瘤的临床和预后特征，评估治疗策略和长期预后，改善松果体区脑膜瘤的管理。我们回顾性研究了 2009 年至 2021 年期间在四川大学华西医院接受手术切除松果体区脑膜瘤的 37 例患者的数据。根据切除程度（EOR）行辅助伽玛刀放射外科治疗（GKRS）。采用无进展生存期（PFS）、卡氏行为状态评分（KPS）和神经功能恢复来评估松果体区脑膜瘤的综合管理策略。最常见的症状是与颅内压升高相关的头痛（75.7%）。大多数情况下采用枕下入路（40.5%）和幕上小脑幕下入路（29.7%）。27 例患者达到大体全切除（GTR），其余患者行次全切除（STR）联合术后 GKRS。平均随访 87.0 个月，进展率为 10.0%，5 年 PFS 率为 92.9%，ΔKPS 为 16.3。多因素分析显示，STR+GKRS 和幕上小脑幕下入路有利于患者生活质量的恢复。松果体区脑膜瘤是散发性的，但具有挑战性。有必要为松果体区脑膜瘤患者选择最合适的手术入路、EOR 和脑积水治疗策略。最大限度地安全切除以保护神经血管功能，结合术后 GKRS 可显著提高患者的生活质量。
