Silva Carlos Eduardo da, Vidaletti Tamara
Department of Neurosurgery and Skull Base Surgery, Hospital Ernesto Dornelles, Porto Alegre, Rio Grande do Sul, Brazil.
Anatomy, DCBS, Universidade Federal de Ciências da Saúde de Porto Alegre, UFCSPA, Porto Alegre, Rio Grande do Sul, Brazil.
J Neurol Surg B Skull Base. 2024 Mar 28;86(2):199-207. doi: 10.1055/a-2273-5509. eCollection 2025 Apr.
Giant meningiomas invading the cavernous sinus (GMICSs) are a subgroup of challenging tumors due to their volume and the extent of neurological impairment. Preserving quality of life is one of the most relevant aspects of treating patients with GMICS. A retrospective study was conducted for surgeries performed between 2012 and 2022, including 33 patients presenting meningiomas with the largest diameter of at least 5 cm invading the cavernous sinus. The data from surgical intervention, Simpson grade of resection, tumor location, and morbimortality related to the surgeries were reviewed. The group comprised 25 women and 8 men with a median age of 56 years. The mean follow-up period was 52 months. The tumors were in the sphenoid wing, anterior clinoid, spheno-orbital, spheno-petroclival, petroclival, and Meckel's cave. Simpson grade I, II, and III were obtained in 70% of cases. The meningiomas were classified as WHO grade 1 in 94%, grade 2 in 3%, and grade 3 in 3%. The overall mortality was 3%. Permanent cranial nerve deficits occurred in 21%, transient cranial nerve deficits in 42%, cerebrospinal fistula in 15%, and hemiparesis in 18%. The recurrence/regrowth rate was 6%. The Karnofsky Performance Status score of 100 and 90 was 82%. The surgical treatment of GMICS is an effective treatment modality with acceptable morbimortality and good long-term control. Involvement of the internal carotid artery is essential to determine the extent of resection inside the cavernous sinus, and training in the microsurgical laboratory is mandatory for safe surgical treatment.
巨大侵袭性海绵窦脑膜瘤（GMICSs）因其体积和神经功能损害程度而成为一类具有挑战性的肿瘤。保留生活质量是治疗GMICS患者最相关的方面之一。
对2012年至2022年期间进行的手术进行了一项回顾性研究，包括33例最大直径至少5厘米的侵袭海绵窦的脑膜瘤患者。回顾了手术干预、辛普森切除分级、肿瘤位置以及与手术相关的病死率和发病率的数据。
该组包括25名女性和8名男性，中位年龄为56岁。平均随访期为52个月。肿瘤位于蝶骨翼、前床突、蝶眶、蝶岩斜、岩斜和梅克尔腔。70%的病例获得了辛普森I级、II级和III级切除。94%的脑膜瘤被分类为世界卫生组织1级，3%为2级，3%为3级。总死亡率为3%。永久性脑神经缺损发生率为21%，暂时性脑神经缺损为42%，脑脊液瘘为15%，偏瘫为18%。复发/再生长率为6%。卡诺夫斯基功能状态评分为100分和90分的比例为82%。
GMICS的手术治疗是一种有效的治疗方式，具有可接受的病死率和发病率，且长期控制效果良好。颈内动脉的受累情况对于确定海绵窦内的切除范围至关重要，安全的手术治疗必须在显微外科实验室进行培训。
