Indications for surgery in patients with asymptomatic meningiomas based on an extensive experience
Indications for surgery in patients with asymptomatic meningiomas based on an extensive experience
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DOI：
10.3171/jns.2006.105.4.538
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发表时间：
2006-10-01
影响因子：
4.1
通讯作者：
Kuratsu, Jun-ichi
中科院分区：
文献类型：
--
作者：
Yano, Shigetoshi;Kuratsu, Jun-ichi
Object.为了确定无症状脑膜瘤患者的手术指征，作者回顾性分析了无症状脑膜瘤的自然病程和手术结果，然后将其与有症状脑膜瘤的自然病程和手术结果进行比较。在1989年至2003年期间，1434名在日本熊本县接受治疗的脑膜瘤患者被纳入本研究。603例患者无症状病灶，831例有症状病灶。作者分析了检测时病变的大小，它们随时间的生长，以及与先前无症状脑膜瘤相关的任何症状表现。作者比较了不同部位无症状和有症状脑膜瘤的手术相关发病率，在603例无症状脑膜瘤中，351例（58.2%）保守治疗。在参与5年以上随访的67例患者中，有25例（37.3%）观察到肿瘤生长，在平均3.9年的随访期内，67例患者中有11例（16.4%）出现症状。在213例手术治疗的无症状脑膜瘤患者中，70岁以下患者的发病率为4.4%，70岁或以上患者的发病率为9.4%。虽然无症状性病变的总发病率低于有症状性病变，但无症状性病变位于凸部或假部的患者总发病率超过6%。大约63%的无症状脑膜瘤没有表现出肿瘤生长，只有6%的患者在观察期间出现症状。为了避免无症状脑膜瘤患者手术相关的发病率，保守治疗和密切随访可能是最好的治疗策略。
Object. To determine the indications for surgery in patients harboring asymptomatic meningiomas, the authors retrospectively analyzed the natural course and surgical outcome of asymptomatic meningiomas and then compared these to the natural course and surgical outcome of symptomatic meningiomas.Methods. Between 1989 and 2003, 1434 patients harboring meningiomas, who were treated in Kumamoto Prefecture, Japan, were enrolled in this study. Six hundred three patients had asymptomatic lesions and 831 had symptomatic ones. The authors analyzed the sizes of the lesions at detection, their growth over time, and any appearances of symptoms associated with previously asymptomatic meningiomas. The authors then compared the surgery-related morbidity rates associated with asymptomatic and symptomatic meningiomas arising at different locations.Of the 603 asymptomatic meningiomas, 351 (58.2%) were treated conservatively. Tumor growth was observed in 25 (37.3%) of 67 patients who participated in follow up for longer than 5 years, and symptoms developed in 11 (16.4%) of the 67 patients over a mean follow-up period of 3.9 years. Among the 213 patients with surgically treated asymptomatic meningiomas, the morbidity rate was 4.4% in patients younger than 70 years of age and 9.4% in those 70 years of age or older. Although the total morbidity rate was lower in patients with asymptomatic lesions than in those with symptomatic ones, it exceeded 6% in patients whose asymptomatic tumors were located at the convexity or falx.Conclusions. Approximately 63% of asymptomatic meningiomas did not exhibit tumor growth, and only 6% of all patients with these lesions experienced symptoms during the observation period. To avoid surgery-related incidences of morbidity in patients with asymptomatic meningiomas, conservative treatment with close follow-up review may be the best therapeutic strategy.