Natural history of cavernous sinus meningiomas
Natural history of cavernous sinus meningiomas
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DOI：
10.3171/2017.7.jns17662
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发表时间：
2019-02-01
影响因子：
4.1
通讯作者：
Boch, Anne-Laure
中科院分区：
文献类型：
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作者：
Amelot, Aymeric;van Effenterre, Remy;Boch, Anne-Laure
目的：局限于海绵窦的脑膜瘤是一种良性肿瘤。由于严重并发症的高风险，海绵内手术被放弃，转而采用放射治疗。然而，由于这种病变的自然历史尚未被描述，治疗的选择仍然很复杂。方法：作者对53例连续的MCSs患者进行前瞻性研究，研究该病变的自然历史。从1990年到2016年，中位随访时间为10.2年（范围2-25年）。结果患者年龄30 ~ 72岁，平均53岁。脑膜瘤的诊断有主要症状（28例患者主要有动眼肌麻痹和神经痛）、轻微症状（15例患者有头痛、间歇性复视）或偶然发现（10例患者）。简单的对症治疗（短期使用皮质类固醇和卡马西平）使28例出现严重症状的患者中19例（67.9%）无症状，15例最初出现轻微症状的患者中12例（80%）无症状（p < 0.0001）。所有偶然发现的患者均无症状。53例MCSs中44例（83%）未表现出任何显著生长，53例患者中42例（80%）在随访结束时无症状（p < 0.001）。5年、10年和20年的x线无进展生存率（+/- SD）分别为90% +/- 4.2%、82% +/- 5.7%和70% +/- 10.2%。5名患者（9.4%）没有证据表明初始药物治疗有任何效果，需要额外的常规放射治疗。结论由于MCSs的生长变化无常、不可预测、缓慢，且患者间生长变异性高，对症治疗是一种非常有效的治疗方法。这个系列显示这些病变在自然、临床和放射学上都是无痛的。
OBJECTIVE Meningiomas confined to the cavernous sinus (MCSs) are benign tumors. Due to the high risk of severe complications, the intracavernous surgical procedure was abandoned in favor of radiotherapy. However, the choice of treatment remains complicated due to the fact that the natural history of this lesion has not yet been described.METHODS The authors studied the natural history of this lesion using a prospective series of 53 consecutive patients suffering from MCSs. The median follow-up duration was 10.2 years (range 2-25 years), from 1990 to 2016.RESULTS Patients ranged in age from 30 to 72 years (mean 53 years). The meningiomas were diagnosed by major symptoms (mainly oculomotor palsy and neuralgia experienced in 28 patients), minor symptoms (headache, intermittent diplopia in 15 patients), or incidental findings (10 patients). Simple symptomatic treatment (short courses of corticosteroids and carbamazepine) allowed patients to become asymptomatic in 19 (67.9%) of 28 cases experiencing major symptoms, and for 12 (80%) of 15 patients with initial minor symptoms (p < 0.0001). All patients with incidental findings remained asymptomatic. Forty four (83%) of 53 MCSs did not show any significant growth and 42 (80%) of 53 patients were not symptomatic at the end of follow-up (p < 0.001). The radiographic progression-free survival rates (+/- SD) at 5, 10, and 20 years were 90% +/- 4.2%, 82% +/- 5.7%, and 70% +/- 10.2%, respectively. Five patients (9.4%) with no evidence of any effect of the initial medical treatment desired additional conventional radiation therapy.CONCLUSIONS Because of the capricious, unpredictable, and slow growth of MCSs, together with high growth variability from one patient to the next, the symptomatic medical treatment of these tumors is a highly effective method. This series shows that these lesions are naturally, clinically, and radiologically indolent.