Zuluaga-Garcia Juan P, Ramirez-Ferrer Esteban, Peeters Sophie F, DeMonte Franco, Raza Shaan M
Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
J Neurooncol. 2025 Jun 19. doi: 10.1007/s11060-025-05111-z.
To assess clinical, radiographic, surgical, and pathological factors affecting outcomes in patients with skull-base meningiomas (SBMs) with extracranial extension, focusing on extent of resection (EOR), recurrence rates, postoperative complications, and skull-base (SB) reconstruction strategies.
We conducted a retrospective cohort study of 101 patients with SBMs and transcranial extension treated surgically between 1993 and 2024. Tumors were categorized by the Irish classification (Zones I-III). We collected demographics, imaging, surgical details (approach and EOR), pathology (WHO grade, brain invasion, cranial-nerve involvement), and adjuvant therapy. Primary outcomes included gross total resection (GTR) rate, postoperative complications, progression-free survival (PFS), and overall survival (OS). Multivariable Cox-regression and Firth's-logistic regression identified independent predictors.
Zone I was most common (47%), with orbital (41%) and infratemporal-fossa (18%) extension. GTR was achieved in 61.4% overall-highest in Zone I (70.2%). Cerebrospinal-fluid leaks occurred in 8% (highest in Zone III, 27%), and wound infections in 2.9%, none requiring debridement. Tumor recurrence occurred in 40%; subtotal resection (STR; hazard ratio [HR] 2.73, p = 0.014), WHO grade III (HR 27.3, p = 0.003), cranial-nerve dysfunction, and brain invasion independently predicted reduced PFS. STR, Simpson grade > 1, cavernous-sinus invasion, and brain invasion predicted worse OS. Multidisciplinary SB reconstruction using autologous grafts and prosthetic materials (PEEK, titanium mesh) was essential to minimize morbidity.
SBMs with extracranial extension present complex surgical challenges. EOR, tumor histology, and invasion of critical structures significantly influence recurrence and survival. Tailored surgical planning by zone and comprehensive SB reconstruction are critical to optimize outcomes and reduce postoperative morbidity.
评估影响颅底脑膜瘤（SBM）伴颅外扩展患者预后的临床、影像学、手术和病理因素，重点关注切除范围（EOR）、复发率、术后并发症及颅底（SB）重建策略。
我们对1993年至2024年间接受手术治疗的101例伴有经颅扩展的SBM患者进行了一项回顾性队列研究。肿瘤根据爱尔兰分类法（I - III区）进行分类。我们收集了人口统计学资料、影像学资料、手术细节（入路和EOR）、病理（世界卫生组织分级、脑侵犯、颅神经受累情况）及辅助治疗情况。主要结局包括全切除（GTR）率、术后并发症、无进展生存期（PFS）和总生存期（OS）。多变量Cox回归和Firth逻辑回归确定了独立预测因素。
I区最为常见（47%），伴有眶部（41%）和颞下窝（18%）扩展。总体GTR率为61.4%，I区最高（70.2%）。脑脊液漏发生率为8%（III区最高，为27%），伤口感染率为2.9%，均无需清创。肿瘤复发率为40%；次全切除（STR；风险比[HR] 2.73，p = 0.014）、世界卫生组织III级（HR 27.3，p = 0.003）、颅神经功能障碍和脑侵犯独立预测PFS降低。STR、辛普森分级>1、海绵窦侵犯和脑侵犯预测OS更差。使用自体移植物和人工材料（聚醚醚酮、钛网）进行多学科SB重建对于将发病率降至最低至关重要。
伴有颅外扩展的SBM带来了复杂的手术挑战。EOR、肿瘤组织学及关键结构的侵犯显著影响复发和生存。按区域进行个性化手术规划和全面的SB重建对于优化结局和降低术后发病率至关重要。
