Management of skull base meningiomas with extracranial extension: resection, recurrence, and prognostic factors.

IF 3.2 2区医学 Q2 CLINICAL NEUROLOGY

Journal of Neuro-Oncology Pub Date : 2025-06-19 DOI:10.1007/s11060-025-05111-z

Juan P Zuluaga-Garcia, Esteban Ramirez-Ferrer, Sophie F Peeters, Franco DeMonte, Shaan M Raza

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引用次数: 0

Abstract

Purpose: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

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颅底脑膜瘤伴颅外延伸的治疗：切除、复发及预后因素。

目的：评估影响颅外延伸颅底脑膜瘤（SBMs）患者预后的临床、影像学、外科和病理因素，重点关注切除程度（EOR）、复发率、术后并发症和颅底（SB）重建策略。方法：我们对1993年至2024年间101例经颅延伸手术治疗的sbm患者进行了回顾性队列研究。肿瘤按爱尔兰分类（I-III区）进行分类。我们收集了人口统计学、影像学、手术细节（入路和EOR）、病理（WHO分级、脑侵犯、颅神经受累）和辅助治疗。主要结局包括总切除（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 -logistic回归确定了独立的预测因子。结果：I区最常见（47%），眼眶延伸（41%）和颞下窝延伸（18%）。总体GTR为61.4%，I区最高（70.2%）。脑脊液漏发生率为8%（最高为III区，27%），伤口感染发生率为2.9%，均不需要清创。肿瘤复发率为40%；次全切除；风险比[HR] 2.73, p = 0.014)、WHO III级（HR 27.3, p = 0.003）、脑神经功能障碍和脑侵犯独立预测PFS降低。STR、Simpson bbb1级、海绵窦侵犯和脑侵犯预示更差的OS。多学科SB重建使用自体移植物和假体材料（PEEK，钛网）是必要的，以尽量减少发病率。结论：伴有颅外延伸的SBMs存在复杂的手术挑战。EOR、肿瘤组织学和关键结构的侵袭显著影响复发和生存。有针对性的手术规划区域和全面的SB重建是优化结果和降低术后发病率的关键。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Neuro-Oncology 医学-临床神经学

CiteScore

6.60

自引率

7.70%

发文量

277

审稿时长

3.3 months

期刊介绍： The Journal of Neuro-Oncology is a multi-disciplinary journal encompassing basic, applied, and clinical investigations in all research areas as they relate to cancer and the central nervous system. It provides a single forum for communication among neurologists, neurosurgeons, radiotherapists, medical oncologists, neuropathologists, neurodiagnosticians, and laboratory-based oncologists conducting relevant research. The Journal of Neuro-Oncology does not seek to isolate the field, but rather to focus the efforts of many disciplines in one publication through a format which pulls together these diverse interests. More than any other field of oncology, cancer of the central nervous system requires multi-disciplinary approaches. To alleviate having to scan dozens of journals of cell biology, pathology, laboratory and clinical endeavours, JNO is a periodical in which current, high-quality, relevant research in all aspects of neuro-oncology may be found.