Petroclival meningiomas: long-term outcomes of multimodal treatments and management strategies based on 30 years of experience at a single institution
Petroclival meningiomas: long-term outcomes of multimodal treatments and management strategies based on 30 years of experience at a single institution
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DOI：
10.3171/2019.2.jns182604
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发表时间：
2020-06-01
影响因子：
4.1
通讯作者：
Lee, Sang Hyung
中科院分区：
文献类型：
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作者：
Kim, Jin Wook;Jung, Hee-Won;Lee, Sang Hyung
目的：需要对岩斜区脑膜瘤多模式治疗的长期结果和时间变化进行全面调查，以建立最佳的治疗策略。作者回顾性分析了岩斜脑膜瘤患者的长期临床结局，根据不同的治疗方法，包括不同的手术入路，并根据一家机构30年的经验提出了治疗策略。方法1986年至2015年，作者所在机构对92例岩斜脑膜瘤患者进行了手术治疗。对患者的人口统计学资料、总生存率、局部肿瘤控制率和根据多模式治疗的功能结局以及管理策略的时间变化进行了评价。平均临床和影像学随访时间分别为121个月（范围1-368个月）和105个月（范围1-348个月），分别为。结果后经岩骨入路是最常见的选择，并遵循44例（48%）;一个简单的乙状窦后入路，进行了30例，是第二个最常见的。将初始切除范围和随后的辅助治疗方式分为3个亚组：13例患者仅进行大体全切除（GTR）; 56例患者进行非GTR治疗，随后进行辅助放射外科手术或放射治疗（非GTR +RS/RT）; 23例患者进行非GTR无辅助治疗（仅非GTR）。5年和10年的总体无进展生存率分别为85.8%和81.2%。根据每个亚组的进展或复发率分别为7.7%，12.5%，和30.4%，respectively.CONCLUSIONS作者的首选多模式治疗策略，计划不完全切除和随后的辅助放射外科治疗，是一个可行的选择与大型岩斜脑膜瘤患者的管理，同时考虑到局部肿瘤控制和术后生活质量。
OBJECTIVE A thorough investigation of the long-term outcomes and chronological changes of multimodal treatments for petroclival meningiomas is required to establish optimal management strategies. The authors retrospectively reviewed the long-term clinical outcomes of patients with petroclival meningioma according to various treatments, including various surgical approaches, and they suggest treatment strategies based on 30 years of experience at a single institution.METHODS Ninety-two patients with petroclival meningiomas were treated surgically at the authors' institution from 1986 to 2015. Patient demographics, overall survival, local tumor control rates, and functional outcomes according to multimodal treatments, as well as chronological change in management strategies, were evaluated. The mean clinical and radiological follow-up periods were 121 months (range 1-368 months) and 105 months (range 1-348 months), respectively.RESULTS A posterior transpetrosal approach was most frequently selected and was followed in 44 patients (48%); a simple retrosigmoid approach, undertaken in 30 patients, was the second most common. The initial extent of resection and following adjuvant treatment modality were classified into 3 subgroups: gross-total resection (GTR) only in 13 patients; non-GTR treatment followed by adjuvant radiosurgery or radiation therapy (non-GTR+RS/RT) in 56 patients; and non-GTR without adjuvant treatment (non- GTR only) in 23 patients. The overall progression-free survival rate was 85.8% at 5 years and 81.2% at 10 years. Progression or recurrence rates according to each subgroup were 7.7%, 12.5%, and 30.4%, respectively.CONCLUSIONS The authors' preferred multimodal treatment strategy, that of planned incomplete resection and subsequent adjuvant radiosurgery, is a feasible option for the management of patients with large petroclival meningiomas, considering both local tumor control and postoperative quality of life.