Treatment modalities and outcomes for asymptomatic meningiomas
Treatment modalities and outcomes for asymptomatic meningiomas
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DOI：
10.1007/s00701-010-0841-0
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发表时间：
2011-01-01
影响因子：
2.4
通讯作者：
Lee, Jung-Il
中科院分区：
文献类型：
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作者：
Jo, Kwang-Wook;Kim, Chang-Hyun;Lee, Jung-Il
本研究的目的是探讨无症状脑膜瘤（MNGs）在观察、显微手术（MS）和伽玛刀放射手术（GKRS）等多种治疗方式后的预后。对1996 ~ 2008年收治的154例无症状mng患者的病历及影像学资料进行回顾性分析。女性121例，男性33例，平均年龄59.2岁（27 ~ 87岁）。治疗方式基本上是根据患者的偏好从观察、MS和GKRS中选择的。平均随访时间为61.2个月（24-157个月）。在我们的患者样本中，77例患者最初选择观察。其中24例（31.2%）患者肿瘤体积增大。其中9例患者需要MS或GKRS，平均持续时间为48.8个月（范围13-134）。在8名患者中进行了MS作为初始治疗，没有导致永久性神经功能障碍。术后无肿瘤复发（平均随访59.6个月，范围24 ~ 108个月）。69例患者行GKRS。经GKRS后，57例患者肿瘤大小稳定，12例患者肿瘤大小减小，无患者肿瘤大小增大（平均随访63.0个月，范围24-110个月）。27例（39.1%）患者出现短暂性并发症，但没有患者出现永久性神经功能缺损。4年和5年无进展生存期（PFS）分别为77.2 +/- 5.5%和61.8% +/- 7.7%。GKRS与观察组PFS差异有统计学意义（p = 0.001）。有很大的可能性生长无症状的mng。GKRS可以降低这种可能性，但由于辐照引起的短暂并发症的风险仍然存在。根据初始治疗，最终结果无显著差异。考虑到临床过程和最终结果，根据患者的喜好，定期随访观察和GKRS可能是无症状mng的合理选择。
The aim of this study is to investigate the outcomes of asymptomatic meningiomas (MNGs) after a variety of treatment modalities, including observation, microsurgery (MS), and gamma knife radiosurgery (GKRS).From 1996 to 2008, 154 patients with asymptomatic MNGs were treated, and their medical records and imaging data were retrospectively analyzed. There were 121 females and 33 males with a mean age of 59.2 years (range 27-87). Treatment modalities were essentially chosen by patient preference from observation, MS, and GKRS. The mean follow-up duration was 61.2 months (range 24-157) from diagnosis.Of our patient sample, 77 patients initially opted for observation. Tumor volume increased in 24 (31.2%) of these patients. MS or GKRS was required in nine of these patients, and the mean duration until intervention was 48.8 months (range 13-134). MS was performed as an initial treatment in eight patients without resulting in permanent neurologic deficit. No tumor recurrence occurred after surgery (mean follow-up 59.6 months; range 24-108). GKRS was performed in 69 patients. After GKRS, tumor size was stable in 57 and decreased in 12 patients, while no patient showed an increase in tumor size (mean follow-up 63.0 months; range 24-110). Transient complications developed in 27 patients (39.1%), though permanent neurologic deficit did not develop in any patient. The progression-free survival (PFS) rates at 4 and 5 years with observation were 77.2 +/- 5.5% and 61.8% +/- 7.7%. The difference in PFS between GKRS and observation was statistically significant (p = 0.001).There is a substantial probability of growth of asymptomatic MNGs. GKRS can lower this possibility, but the risk of transient complications due to irradiation exists. There are no significant differences in final outcome according to initial treatment. Considering the clinical course and final outcome, both observation with regular follow-up and GKRS may be reasonable choices for asymptomatic MNGs according to preference of the patients.