Long-Term Surgical Outcomes of Spinal Meningiomas
Long-Term Surgical Outcomes of Spinal Meningiomas
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DOI：
10.1097/brs.0b013e31824167f1
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发表时间：
2012-05-01
期刊：
影响因子：
3
通讯作者：
Matsumoto, Morio
中科院分区：
文献类型：
--
作者：
Nakamura, Masaya;Tsuji, Osahiko;Matsumoto, Morio
研究设计.回顾性病例系列。目的探讨脊膜瘤的治疗策略。尽管先前的研究已经证明了脊膜瘤良好的手术结果，肿瘤复发率低，但很少有研究长期手术结果。回顾性研究患者年龄、手术切缘状态（Simpson分级）、肿瘤位置和组织学亚型对肿瘤复发的影响。此外，对Simpson I级病例切除的硬脑膜进行侵袭性肿瘤细胞检查，并与磁共振成像上是否存在硬脑膜尾征进行比较。在62例患者中进行了完全切除（Simpson I级和II级）。其中，肿瘤复发率为9.7%，均发生在因腹侧脊柱病变接受II级切除术的患者中。这些患者再次手术的平均持续时间为12.2 +/- 5.2年。在6例接受不完全切除（Simpson III/IV级）的患者中，所有患者均需要再次手术治疗肿瘤复发或再生长，平均5年后。初次手术时年龄小于50岁的患者的复发率明显高于50岁或以上的患者。对43例Simpson I级切除患者的硬脑膜标本进行组织学检查，发现15例患者的内外层之间有肿瘤细胞浸润。在磁共振成像上硬脑膜尾征阴性的28例患者中有8例（29%）发现了这种侵袭，在15例硬脑膜尾征阳性的患者中有7例（47%）发现了这种侵袭。侵袭椎体的哑铃型脑膜瘤MIB-1指数达到约10%;这些与反复复发和不良预后相关。脑膜瘤手术后的长期随访表明，在治疗年轻患者或哑铃型脑膜瘤时，应尽可能选择Simpson I级切除术。平均而言，约30%接受II级切除术的患者在12年时肿瘤复发。
Study Design. Retrospective case series.Objective. To evaluate the treatment strategies for spinal meningioma.Summary of Background Data. Although previous studies have demonstrated favorable surgical outcomes for spinal meningioma, with a low incidence of tumor recurrence, few have examined long-term surgical outcomes.Methods. The influence of patient age, surgical margin status (Simpson grade), tumor location, and histological subtype on tumor recurrence were examined retrospectively. In addition, the resected dura mater from Simpson grade I cases was examined for invasive tumor cells and compared with the presence or absence of a dural tail sign on magnetic resonance image.Results. Complete resection (Simpson grades I and II) was performed in 62 patients. Among them, the tumor recurrence rate was 9.7%, all in patients who underwent grade II resection for ventral spinal lesions. The mean duration to reoperation in these patients was 12.2 +/- 5.2 years. Of the 6 patients who underwent incomplete resection (Simpson grade III/IV), all required reoperation for tumor recurrence or regrowth, 5 years later on average. Patients younger than 50 years at the initial surgery had a significantly higher recurrence rate than those aged 50 years or older. Histologic examination of 43 dura mater specimens from Simpson grade I-resection patients revealed tumor cell invasion between the inner and outer layers in 15 patients. This invasion was noted in 8 (29%) of 28 patients who were negative for the dural tail sign on magnetic resonance image, and in 7 (47%) of 15 patients who showed a positive dural tail sign. The MIB-1 index reached about 10% for dumbbell-type meningiomas invading the vertebral body; these were associated with repeated recurrence and unfavorable prognosis.Conclusion. Long-term follow-up after surgery for meningiomas indicated that Simpson grade I resection should be selected whenever practicable when treating younger patients or dumbbell-type meningiomas. Tumors recurred at 12 years, on average, in approximately 30% of patients who underwent grade II resection.