Black P M
Neurosurgical Service, Brigham and Women's Hospital, Boston, MA 02115, USA.
Can J Neurol Sci. 1997 Nov;24(4):302-6. doi: 10.1017/s0317167100032960.
The understanding and management of meningiomas is changing significantly today. One of the most striking features of their pathophysiology is their predominance in women. In a series of 517 patients with meningiomas seen by the Brain Tumor Group at Brigham and Women's Hospital, the female:male ratio was 24:1. The progesterone receptor appears to be the major candidate to explain this difference. Although meningioma cells variably express receptors for estrogen, androgen, platelet-derived growth factor, epidermal growth factor, and somatostatin, these molecules do not explain the differences because they are not differentially expressed or are not activated. Progesterone receptor can be shown to be expressed in 81% of women and 40% of men with meningiomas; it can also be shown to be activated by transfecting a construct with the progesterone responsive element and a reporter in it and using the cell's own receptors to activate this construct. Surgery remains the mainstay of meningioma management. At the Brigham and Women's Hospital three-dimensional reconstruction techniques have markedly improved the ability to visualize the tumor as well as its relation to vascular structures. With MRI reconstruction, it is possible to know the tumor's relation to the sagittal and other sinuses, to identify feeders and proximity to major arteries, and to establish its location and relation to cortex by frameless stereotaxis. These techniques can be used in a virtual reality format are some of the most powerful in neurosurgery both for teaching and for the surgical procedure itself. External beam radiation has been shown by others to be an effective adjunctive treatment to prevent meningioma recurrence. Recently, linear accelerator radiosurgery and stereotactic radiotherapy have changed the pattern of radiation at our institution. In a series of 56 skull base meningiomas, for example, 95% were controlled (i.e., showed no growth) over a four year period. Fractionated focal radiation potentially offers the same control rate with fewer complications. With increasing understanding and treatment possibilities, meningiomas remain one of the most intriguing and challenging tumors in the nervous system.
如今，脑膜瘤的认识与治疗正在发生显著变化。其病理生理学最显著的特征之一是在女性中更为常见。在布莱根妇女医院脑肿瘤小组诊治的517例脑膜瘤患者中，男女比例为24:1。孕酮受体似乎是解释这种差异的主要候选因素。虽然脑膜瘤细胞可不同程度地表达雌激素、雄激素、血小板衍生生长因子、表皮生长因子和生长抑素的受体，但这些分子并不能解释这种差异，因为它们并非差异表达或未被激活。研究表明，81%的女性脑膜瘤患者和40%的男性脑膜瘤患者可检测到孕酮受体表达；通过转染含有孕酮反应元件和报告基因的构建体，并利用细胞自身受体激活该构建体，也可证实其被激活。手术仍是脑膜瘤治疗的主要手段。在布莱根妇女医院，三维重建技术显著提高了肿瘤及其与血管结构关系的可视化能力。借助MRI重建，可以了解肿瘤与矢状窦及其他窦的关系，识别供血血管及其与主要动脉的距离，并通过无框架立体定向技术确定其位置及其与皮质的关系。这些技术以虚拟现实形式应用，是神经外科教学和手术操作中最强大的工具之一。其他人已证明外照射是预防脑膜瘤复发的有效辅助治疗方法。最近，直线加速器放射外科和立体定向放射治疗改变了我们机构的放疗模式。例如，在一组56例颅底脑膜瘤患者中，95%在四年内得到控制（即无生长）。分次局部放疗可能在并发症较少的情况下提供相同的控制率。随着认识的不断深入和治疗方法的增多，脑膜瘤仍然是神经系统中最引人入胜且具有挑战性的肿瘤之一。
