Kozlov A V, Efremov K V, Galkin M V, Kvan O K, Ryzhova M V, Strunina Yu A, Titov O Yu, Tanyashin S V
Burdenko Neurosurgical Center, Moscow, Russia.
Andijan State Medical Institute, Andijan, Uzbekistan.
Zh Vopr Neirokhir Im N N Burdenko. 2025;89(1):20-29. doi: 10.17116/neiro20258901120.
To date, 16 cases of en plaque hyperostotic meningioma of the convexity have been described. There are no clinical guidelines for the treatment of such patients.
To study the factors influencing the results of surgical treatment of en plaque convexity hyperostotic meningioma, to formulate the appropriate decision-making algorithm.
A retrospective total group of 69 patients with en plaque convexity hyperostotic meningioma who underwent surgery at Burdenko Neurosurgical Center between 2014 and 2023. We analyzed clinical manifestations, tactics and results of surgery and radiotherapy using statistical methods.
Total resection of small local non-infiltrative hyperostotic meningioma not involving the superior sagittal sinus did not cause neurological deterioration. In case of spread infiltrative hyperostotic meningiomas, the best results (including regression of intracranial hypertension in all cases) were obtained after non-radical surgeries (resection of hyperostosis without wide excision of the dura or even without dura opening). Extent of resection of involved dura and intracranial tumor did not affect relapse-free survival. Additional morbidity at discharge from the clinic was 35%, after ≥6 months - 16%. The most common (27.5%) complication was pseudomeningocele. Redo surgery rate for pseudomeningocele - 7%, hematomas - 7%, wound infection - 6%. There were no mortality in the series. Radiotherapy increased relapse-free survival without statistical confirmation.
Total resection provides optimal results in patients with small convexity hyperostotic meningioma and no brain invasion. Resection of hyperostosis and expansive cranioplasty are preferable for large and giant convexity hyperostotic meningioma involving venous sinuses and / or the brain.
迄今为止，已报道16例凸面斑块状骨质增生性脑膜瘤病例。目前尚无针对此类患者的临床治疗指南。
研究影响凸面斑块状骨质增生性脑膜瘤手术治疗效果的因素，制定合适的决策算法。
回顾性分析2014年至2023年在布尔坚科神经外科中心接受手术的69例凸面斑块状骨质增生性脑膜瘤患者。我们采用统计学方法分析了临床表现、手术策略、手术及放疗结果。
不涉及上矢状窦的小范围局部非浸润性骨质增生性脑膜瘤全切未导致神经功能恶化。对于弥漫浸润性骨质增生性脑膜瘤，非根治性手术（切除骨质增生但不广泛切除硬脑膜甚至不打开硬脑膜）后取得了最佳效果（所有病例颅内高压均得到缓解）。受累硬脑膜和颅内肿瘤的切除范围不影响无复发生存率。出院时的额外发病率为35%，≥6个月后为16%。最常见的并发症（27.5%）是假性脑膜膨出。假性脑膜膨出的再次手术率为7%，血肿为7%，伤口感染为6%。该系列病例无死亡。放疗虽提高了无复发生存率，但无统计学依据。
对于无脑侵犯的小凸面骨质增生性脑膜瘤患者，全切可提供最佳治疗效果。对于累及静脉窦和/或脑的大及巨大凸面骨质增生性脑膜瘤，切除骨质增生和扩大性颅骨成形术更为可取。
