Kinjo T, al-Mefty O, Kanaan I
Department of Neurological Surgery, Loyola University Medical Center, Maywood, Illinois.
Neurosurgery. 1993 Sep;33(3):394-9; discussion 399. doi: 10.1227/00006123-199309000-00007.
Although meningiomas are benign intracranial tumors, their frequency of recurrence after surgery has not been as low as expected. The recurrence rate of meningiomas is clearly related to the degree of tumor removal. Simpson Grade I removal, which entails excising the tumor and its dural and sinus attachments, is associated with the lowest rate of recurrence. To further minimize the recurrence of convexity meningiomas, we removed an additional dural margin of about 2 cm around the tumor (Grade 0 removal). For tumors involving bone, we removed the hyperostotic bone with a healthy margin and pericranium in en bloc resection. Between 1982 and 1992, 37 patients (15 men, 22 women) with an average age of 52.1 years were operated on by the above technique. Nineteen had a follow-up period of more than 5 years. To date, no tumors have recurred and no morbid incidences have occurred with this maneuver. We believe that the recurrence rate of convexity meningiomas can be diminished by including in the resection a margin of dura that might harbor a foci of tumor cells.
尽管脑膜瘤是良性颅内肿瘤，但其术后复发频率并未如预期的那样低。脑膜瘤的复发率显然与肿瘤切除程度有关。辛普森一级切除，即切除肿瘤及其硬脑膜和窦附着处，复发率最低。为了进一步降低凸面脑膜瘤的复发率，我们在肿瘤周围额外切除了约2厘米的硬脑膜边缘（0级切除）。对于累及骨质的肿瘤，我们在整块切除时连同健康边缘和颅骨膜一并切除增生的骨质。1982年至1992年间，采用上述技术对37例患者（15例男性，22例女性）进行了手术，平均年龄52.1岁。其中19例随访时间超过5年。迄今为止，采用这种手术方式尚无肿瘤复发，也未发生任何不良事件。我们认为，通过在切除术中纳入可能含有肿瘤细胞灶的硬脑膜边缘，可以降低凸面脑膜瘤的复发率。
