Qasem Lina-Elisabeth, Al-Hilou Ali, Oros Jan, Weber Katharina J, Keil Fee, Jussen Daniel, Prinz Vincent, Seifert Volker, Baumgarten Peter, Marquardt Gerhard, Czabanka Marcus
Center for Neurology and Neurosurgery, Department of Neurosurgery, Goethe University Frankfurt, University Hospital, Frankfurt am Main, Germany.
Department of Neurological Surgery, University Hospital Frankfurt am Main, Schleusenweg 2-16, 60528, Frankfurt am Main, Germany.
Sci Rep. 2025 Mar 7;15(1):7926. doi: 10.1038/s41598-025-92516-5.
Resection of large anterior midline skull base meningiomas with extensive peritumoral edema poses high risks due to postoperative edema decompensation leading to increased intracranial pressure. Initial craniectomy prevents intracranial pressure decompensation but requires secondary cranioplasty. This study compares single-stage osteoplastic craniotomy with tumor resection to a two-stage approach using bifrontal craniectomy, tumor resection and subsequent cranioplasty after edema recovery in a second surgical step. Patients with large anterior midline skull base meningiomas (> 50 mm) and extensive peritumoral edema were included. Group 1 underwent single-stage resection (2002-2016), while Group 2 had a two-stage approach (2012-2022). The primary outcome was the Karnofsky Performance Scale (KPS) at three months post-surgery. Secondary outcomes included preoperative KPS, KPS at discharge and last follow-up, ICU stay, hospital stay length and complication rates. A total of 25 patients were analyzed (Group 1: n = 9; Group 2: n = 16). Group 2 demonstrated significantly improved KPS at three months postoperatively (median KPS 70% vs. 50%; p = 0.0204) with a non-significant reduction in ICU stay (10 vs. 6.5 days; p = 0.3284). Although no significant differences were observed in KPS at discharge (Group 1: KPS 30% vs. Group 2: KPS 50%; p = 0.1829) or last follow-up (Group 1: KPS 60% vs. Group 2: KPS 80%; p = 0.1630), Group 2 patients required fewer postoperative interventions for complications unrelated to cranioplasty. Overall complication rates were comparable in both groups (Group 1: 67% vs. Group 2: 56%; p = 0.6274). Two-stage resection of large anterior midline skull base meningiomas with extensive edema provides superior clinical outcomes at three months postoperatively without increasing overall complication rates. These findings support the use of a two-stage surgical strategy for highly selected patients. However, further multicenter studies are warranted to validate these results in larger cohorts.
切除伴有广泛瘤周水肿的大型前颅底中线脑膜瘤具有较高风险，因为术后水肿代偿失调会导致颅内压升高。初次颅骨切除术可防止颅内压代偿失调，但需要二期颅骨成形术。本研究比较了一期骨成形性开颅术联合肿瘤切除术与二期手术方法，后者采用双额开颅术、肿瘤切除术以及在第二步手术中待水肿消退后进行颅骨成形术。纳入了患有大型前颅底中线脑膜瘤（>50mm）且伴有广泛瘤周水肿的患者。第一组接受一期切除术（2002 - 2016年），而第二组采用二期手术方法（2012 - 2022年）。主要结局指标是术后三个月的卡氏功能状态评分（KPS）。次要结局指标包括术前KPS、出院时及末次随访时的KPS、重症监护病房（ICU）住院时间、住院总时长以及并发症发生率。总共分析了25例患者（第一组：n = 9；第二组：n = 16）。第二组在术后三个月时KPS显著改善（中位数KPS 70% 对50%；p = 0.0204），ICU住院时间虽有非显著性缩短（10天对6.5天；p = 0.3284）。尽管在出院时（第一组：KPS 30% 对第二组：KPS 50%；p = 0.1829）或末次随访时（第一组：KPS 60% 对第二组：KPS 80%；p = 0.1630）未观察到KPS有显著差异，但第二组患者因与颅骨成形术无关的并发症所需的术后干预较少。两组的总体并发症发生率相当（第一组：67% 对第二组：56%；p = 0.6274）。对于伴有广泛水肿的大型前颅底中线脑膜瘤，二期切除术在术后三个月时可提供更好的临床结局，且不增加总体并发症发生率。这些发现支持对经过严格筛选的患者采用二期手术策略。然而，需要进一步开展多中心研究以在更大队列中验证这些结果。
