小脑脑膜瘤:多机构队列研究

IF 3.9 2区 医学 Q1 CLINICAL NEUROLOGY
Neel H Mehta, Ruchit V Patel, Saksham Gupta, Harshit Arora, Noah L Nawabi, Rayha Karanth, Samantha Sadler, Lila Medeiros, Rohan Jha, Velina S Chavarro, Joshua D Bernstock, Timothy R Smith, Omar Arnaout
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引用次数: 0

摘要

背景和目的:小脑视角脑膜瘤(CPA)由于靠近神经血管结构而具有挑战性。术后并发症和持续症状会使患者变得虚弱,而我们预测康复过程的能力仍然参差不齐。在此,我们研究了CPA脑膜瘤患者的表现、管理和预后:我们回顾性研究了在布里格姆综合医院切除的CPA脑膜瘤,使用描述性统计和逻辑回归来确定进展或复发的预测因素:共发现 95 名患者(中位年龄 59.1 岁,82.1% 为女性),他们最常见的症状是听力下降(49.5%)、共济失调(42.1%)和头痛(29.5%)。切除时最常采用的是后蝶鞍(78.9%)或经蝶鞍后蝶鞍(17.9%)入路,62.1%的患者实现了大体全切除(GTR):辛普森 1 级(32.6%)、2 级(17.9%)和 3 级(11.6%)。肿瘤体积较小(t = 3.17,P = .002)与 GTR 相关。对于有耳内侵犯的肿瘤,钻孔内耳道(IAC)也与 GTR 相关(χ2 = 21.8,P < .001)。在有侵犯的病例中,88.5% 的病例在钻孔 IAC 后达到了 GTR,而未钻孔 IAC 的病例只有 11.8%。颅神经 VII/VIII 复合体经常位于脑膜瘤的下方(45.6%)或上方(19.1%)。在最后的临床随访中(中位数:39.4个月),大多数患者术后听力损失稳定(38.7%)或有所改善(54.8%)。25.3%的患者肿瘤进展/复发,世界卫生组织1级肿瘤(中位数:3.0年,IQR:2.9年)和世界卫生组织2级肿瘤(中位数:1.6年,IQR:2.8年)之间存在一定差异。经过多变量调整后,辛普森分级 I 级(P = .02)、辛普森分级 II 级(P = .01)或年龄较大(P = .003)与较低的进展/复发几率相关:结论:GTR对于实现最佳症状控制和降低CPA脑膜瘤的恶化/复发率仍然至关重要。在有脑室内侵犯的肿瘤中,IAC钻孔是预测GTR的一个重要指标。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Cerebellopontine Angle Meningiomas: A Multi-Institutional Cohort Study.

Background and objectives: Cerebellopontine angle (CPA) meningiomas present challenges given their proximity to neurovascular structures. Postoperative complications and persistent symptoms can debilitate patients, and our ability to predict recovery course remains variable. Here, we examine the presentation, management, and outcomes of patients with CPA meningiomas.

Methods: We retrospectively reviewed CPA meningiomas resected at Mass General Brigham, using descriptive statistics and logistic regression to identify predictors of progression or recurrence.

Results: In total, 95 patients were identified (median age 59.1 years, 82.1% female) who presented most commonly with hearing loss (49.5%), ataxia (42.1%), and headaches (29.5%). The retrosigmoid (78.9%) or transmastoid retrosigmoid (17.9%) approaches were most frequently used for resection, with gross total resection (GTR) achieved in 62.1% of patients: Simpson grade 1 (32.6%), grade 2 (17.9%), and grade 3 (11.6%). Smaller tumor size (t = 3.17, P = .002) is associated with GTR. For tumors with intracanalicular invasion, drilling the internal auditory canal (IAC) was also associated with GTR (χ2 = 21.8, P < .001). Among cases with invasion, GTR was achieved in 88.5% of cases when the IAC was drilled vs 11.8% of cases when the IAC was not drilled. The cranial nerve VII/VIII complex was frequently inferior (45.6%) or superior (19.1%) to the meningioma. Postoperative hearing loss was stable (38.7%) or improved (54.8%) in most of patients at the final clinical follow-up (median: 39.4 months). 25.3% of patients had progression/recurrence, with some difference between World Health Organization grade 1 (median: 3.0 years, IQR: 2.9 years) and World Health Organization grade 2 (median: 1.6 years, IQR: 2.8 years) tumors. After multivariate adjustment, Simpson grade I (P = .02), Simpson grade II (P = .01), or being of older age (P = .003) were associated with lower odds of progression/recurrence.

Conclusion: GTR remains critical to achieve optimal symptom control and reduce progression/recurrence rates for CPA meningiomas. Drilling the IAC is an important predictor of GTR in tumors with intracanalicular invasion.

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来源期刊
Neurosurgery
Neurosurgery 医学-临床神经学
CiteScore
8.20
自引率
6.20%
发文量
898
审稿时长
2-4 weeks
期刊介绍: Neurosurgery, the official journal of the Congress of Neurological Surgeons, publishes research on clinical and experimental neurosurgery covering the very latest developments in science, technology, and medicine. For professionals aware of the rapid pace of developments in the field, this journal is nothing short of indispensable as the most complete window on the contemporary field of neurosurgery. Neurosurgery is the fastest-growing journal in the field, with a worldwide reputation for reliable coverage delivered with a fresh and dynamic outlook.
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