脑膜瘤FCM分析与肿瘤全切除术后复发及病理学的关系

目的探讨与脑膜瘤全切除术后复发相关的流式细胞术(FCM)指标.方法分析95例脑膜瘤的流式细胞术(FCM)检测结果,探讨FCM分析的DNA指数(DI)、DNA倍性和增殖指数(PI)与肿瘤复发的关系.结果病理级别越高,DI值越高(P<0.05);复发组DI值高于非复发组(P<0.001);超二倍体肿瘤病理级别高于二倍体及亚二倍体肿瘤(P<0.01),超二倍体肿瘤复发率高于二倍体和亚二倍体肿瘤(P<0.005).Ⅱ级及Ⅲ级脑膜瘤PI值高于Ⅰ级(P<0.05),复发组PI值高于非复发组(P<0.001).结论 FCM表现为超二倍体、高DI和高PI的脑膜瘤易于复发.     

脑膜瘤术后复发的相关因素分析

目的 探讨脑膜瘤术后复发的相关因素.方法 回顾性研究405例颅内脑膜瘤,对其临床资料进行统计学分析,寻找复发的相关因素.结果 37例脑膜瘤术后复发,其特点表现为患者年轻、术前存在癫痫、肿瘤基底位于矢状窦旁及鞍结节、蝶骨嵴、颅眶沟通等颅底部位、体积大、不规则形、瘤周水肿明显或瘤内存在低密度、手术切除程度低或病理级别高.结论 脑膜瘤术后复发的相关因素包括年龄、术前癫痫、肿瘤部位、最大径、形状、瘤周水肿、病理类型以及手术切除程度等.     

颅内良性脑膜瘤全切除术后的复发问题

本文对14例颅内良性脑膜瘤的术后复发原因进行了探讨。支持手术切除级别是影响复发的重要因素的观点;认为受累硬膜明显增厚时,电灼处理可能残留肿瘤组织。肿瘤质软、包膜不完整、有脑浸润和颅骨受累时应注意避免残留。光镜下的灶性坏死,核多形性、细胞成分增多等表现可以作为肿瘤复发的预示因素。     

脑膜瘤全切除术后复发与其MRI影像学特征相关性分析

目的探讨高复发脑膜瘤的MRI影像学特征,以及MRI影像学特征与脑膜瘤病理分级及增殖细胞核抗原(PCNA)表达的关系,以指导临床治疗和预后评估。方法选取自1992年至2002年经我科诊治的有MRI资料的脑膜瘤病例(SimpsonⅠ级和Ⅱ级切除)77例,分为复发组与非复发组,比较两组患者的MRI影像学特征;并应用石蜡标本进行病理学检查及PCNA免疫组织化学检测,比较分析MRI特征与肿瘤复发及病理分级和PCNA标记指数(LI)的关系。结果①分叶状或蘑菇状、边界不清和位于大的静脉窦周围的脑膜瘤复发率较高,脑膜尾征与脑膜瘤的复发无关;②脑膜瘤的PCNALI值大者易复发;③内皮型脑膜瘤复发率高于其他类型脑膜瘤,病理分级级别越高越易复发。结论分叶状或蘑菇状、边界不清和位于大的静脉窦周围的脑膜瘤易复发,临床应采取综合措施,延缓或避免肿瘤复发。     

脑膜瘤全切除术后复发的相关临床及CT特征

分析我院203例脑膜瘤患者的临床和CT资料，并与病理分级相联系，以期术前依临床和CT表现对脑膜瘤复发的可能性进行预测。     

脑膜瘤术后复发因素的回顾性分析

脑膜瘤是颅内常见良性肿瘤，完全切除后一般不再复发，但仍有高达5％～15％的复发率。因此脑膜瘤的复发，仍是神经外科关注的重要课题。笔者通过对178例脑膜瘤手术患者进行回顾性分析，探讨脑膜瘤术后复发的主要因素。     

影响脑膜瘤全切术后复发的生物学因素

脑膜瘤是常见的颅内良性肿瘤,约占颅内肿瘤20%左右.手术治疗效果较好,但全切除术后仍有一定的复发倾向,良性脑膜瘤全切除术后10年内复发率约为9%～15%.手术切除程度一直被认为是影响脑膜瘤术后复发的最主要因素,但随着对复发脑膜瘤生物学特性的深入研究,发现有多种生物学因素与脑膜瘤的术后复发关系密切.     

良性脑膜瘤术后复发的有关问题

关于良性脑膜瘤术后复发的现象颇受关注。本文详细综述了文献上对脑膜瘤术后复发的原因(与原发癌手术、病理的关系,多中心起源学说及其他因素)、复发性脑膜瘤的病理改变、临床评价及影像学诊断等问题的研究和认识。     

脑膜瘤术后复发因素的研讨

本文总结137例恼膜瘤中经再手术证实的复发性脑膜瘤16例,对其可能复发原因加以分析。同时对24例良性恼膜瘤周边局限性硬恼膜组织行肉眼及分块光镜检查,有阳性发现共18例。结果提示:影响脑膜瘤术后复发,可用肿瘤周边多灶性病变未广泛切除的理论来解释。并指出切除肿瘤周边硬脑膜的范围及硬脑膜缺损的处理意见。     

脑膜瘤术后复发相关因素的研究进展

脑膜瘤的术后复发受多种因素的影响,其中手术切除程度是最重要的因素.另外,肿瘤的病理学性质、影像学特征、增殖活性、凋亡指数、遗传学特征、端粒酶活性、激素受体及生长因子等也与脑膜瘤的复发有密切关系.     

脑膜瘤复发的多因素研究

目的探讨诸多临床因素和影像学特征对脑膜瘤复发的影响。以便能有效地早期预防和控制脑膜瘤复发,改善其预后。方法回顾1993-1998年武汉大学中南医院神经外科经手术治疗脑膜瘤患者156例,对其临床诊治过程和影像学资料进行分析,分析其临床因素如性别、年龄、术前KPS(KarnofskyPerfor-manceScale)评分、术后KPS评分、手术切除程度、组织学类型和影像学特征如瘤周水肿、肿瘤形状、肿瘤大小、骨质改变、肿瘤部位、钙化、瘤周边界、CT增强形态。应用SPSS11.07软件,进行单因素分析和多因素分析。多因素分析应用二值多元logic回归模型,以诸多临床因素和影像学特征作为自变量,复发与否作为因变量。结果经单因素分析显示:肿瘤形状、肿瘤大小、瘤周水肿、组织学类型、手术切除程度、肿瘤部位和CT增强形态与脑膜瘤复发有明显关系。多因素分析显示:肿瘤形状、肿瘤大小、肿瘤部位、瘤周水肿、组织学类型、手术切除程度和CT增强形态是影响脑膜瘤复发的主要因素。其它因素在单因素分析及多因素分析中均显示对脑膜瘤复发无明显影响。结论脑膜瘤手术切除程度、组织学类型和CT扫描增强对脑膜瘤复发有明显影响。可作为预测脑膜瘤复发的显著危险因子和标准。     

Low recurrence after Simpson grade II resection of spinal benign meningiomas in a single-institute 10-year retrospective study

The objective of this study was to more fully understand the optimal neurosurgical strategy for spinal benign meningiomas from a medium to long-term perspective. This retrospective study included a cohort of 35 patients with a diagnosis of spinal meningioma who were first operated at our institute over the past 10 years and followed-up for at least 2 years after surgery. The inclusion criterion for the study was the pathological diagnosis finally verified as benign meningioma of World Health Organization (WHO) grade 1. The average follow-up duration after surgery was 61.0 months. The location of the spinal meningioma was classified into ventral or dorsal type based on the operative video record and the preoperative MR images. The extent of resection of the spinal meningioma was carefully determined based on the Simpson grade. The average neurological condition was significantly improved at the final follow-up. Simpson grade I or II resection was achieved in 31 of 35 cases (88.6%). No Simpson grade I or II cases showed local recurrence during follow-up. Tumor recurrence was noted in 2 of 4 cases of Simpson grade IV resection. One case has been followed-up without any re-operation because of no neurological deterioration, and the other case underwent stereotactic radiosurgery. This study suggested that meticulous Simpson grade II resection of spinal benign meningiomas of WHO grade 1 may be good enough from a medium to long-term follow-up perspective, though longer follow-up is absolutely necessary.     

脑膜瘤复发因素的术前评估及对策

目的 探讨脑膜瘤复发的相关因素，做到术前预测，为选择合适术式提供依据。方法 对125例脑膜瘤患的术前CT／MRI等影像学资料进行回顾性研究，将可能影响脑膜瘤复发的相关因素进行统计学分析，发现其中规律。结果 脑膜瘤的密度、形状与复发密切相关。结论 密度不均匀且较低、界限不清伴瘤周水肿的脑膜瘤及扁平形脑膜瘤明显易复发；肿瘤附着点处硬膜的广泛切除是防止脑膜瘤复发的关键。     

Value of KI-67/MIB-1 labeling index and simpson grading system to predict the recurrence of who grade I intracranial meningiomas compared to who grade II

Simpson grading of resection has been used as a predictor of intracranial meningioma (IM) recurrence. Histopathological findings, like the Ki-67/MIB-1 labeling index, may be useful in the assessment risk of recurrence. Our objective was to analyze the predictive value of meningioma recurrence using both parameters. We retrospectively studied 322 consecutive patients with histopathological diagnosis of IM WHO grade I and 43 patients with IM WHO grade II in a 13-year period. Multivariate survival analysis was performed. In the WHO grade I IM group, recurrence was observed in 28 patients (8.69%). The Cox regression model for WHO grade I IM, provided a significative hazard ratio (HR) for Ki-67/MIB-1 index ≥3 (HR = 36.35, p < 0.001) and Simpson’s grading resection, grade II (HR = 2.03, p = 0.045), grade III (HR = 3.41, p = 0.034) and grade IV (HR = 19.75, p ≥ 0.001). In the WHO grade II IM group, recurrence was observed in 10 patients (23.25%). The Cox regression model for WHO grade II IM, provided a significative hazard ratio (HR) for Ki-67/MIB-1 index ≥3% (HR = 1.66, p < 0.001) and Simpson’s grading resection grade III (HR = 3.96, p = 0.027). The Kaplan–Meier survival curve showed a similar distribution of survival between WHO grade I IM with Ki-67/MIB-1 ≥3% and WHO grade II IM. In WHO grade I meningiomas, the Ki-67/MIB-1 index and Simpson grading were both independent predictors of recurrence. A similar management protocol should be advisable for WHO grade I with Ki-67/MIB-1 ≥3% and WHO grade II meningiomas.     

脑膜瘤瘤周硬膜组织蛋白酶D表达与肿瘤复发的关系

目的对组织蛋白酶D(cathepsin D)在脑膜瘤及瘤周硬膜中的表达进行研究,并探讨其在Simpson Ⅰ级切除脑膜瘤术后复发中的可能临床意义.方法临床上行Simpson Ⅰ级切除的脑膜瘤51例,术中分别取标本:肿瘤组织51例,瘤周肿瘤侵犯的硬膜组织(A组)44例,瘤周术中肉眼/镜下认为正常的硬膜组织(B组)51例,距瘤缘至少大于6 cm的正常硬膜组织(C组)15例.利用免疫组织化学方法检测各组标本的cathepsin D、增殖细胞核抗原(PCNA)表达.结果Cathepsin D在脑膜瘤组织中的表达与肿瘤的分级相关,在A组、B组、C组硬膜中的表达值分别为0.1366±0.0431、0.1149±0.0239、0.0789±0.0211,各组之间比较有显著性差异.Cathepsin D和PCNA的表达呈正相关.结论Cathepsin D可作为脑膜瘤复发的预测指标之一.脑膜瘤Simpson Ⅰ级切除后瘤周肉眼/镜下认为正常的硬膜组织在分子蛋白水平已有肿瘤细胞的残存或浸润,是术后复发的原因之一,Simpson 0级切除值得临床推荐.     

Prediction of recurrence in meningiomas after surgical treatment

Summary The prognostic significance of nuclear count, nuclear area fraction, and mean nuclear area estimated by automatic image analysis was evaluated in benign meningiomas. One hundred thirty-two meningiomas without recurrences, 39 meningiomas that recurred, and 40 first recurrences were examined. The tumors were classified according to age and eex of patients, localization, and histology; and the correlation between these parameters and the recurrence rate was assessed.The nuclear counts were identical in paraffin sections from meningiomas without recurrences (6.1 nuclei per 1,000 m²) and in meningiomas that recurred (6.4 nuclei per 1,000 m²). The cell count in the recurrences (7.4 nuclei per 1,000 m²) was higher than in the primary tumors. The same relationship was found for the nuclear area fractions, which were identical in primary meningiomas without recurrences and in meningiomas that recurred. The nuclear area fraction was increased in recurrences. The mean nuclear areas were identical in all groups. The histological type was of little significance in prediction of recurrence rate, although bone invasion and necrosis were of some significance. We found a higher recurrence rate in parasagittal meningiomas. Meningiomas that recurred appeared in a younger age group than other meningiomas, and the recurrence rate was higher for males than for females.Supported by grant no. 512-10141 from the Danish Medical Research Council     

经乙状窦后入路次全切除岩斜区脑膜瘤策略分析

目的探讨经乙状窦后入路治疗岩斜区脑膜瘤的理想切除目标以提高患者术后生活质量。方法回顾分析39例经乙状窦后入路行肿瘤全切除术或次全切除术的岩斜区脑膜瘤患者的临床资料。结果肿瘤全切除者11例(28.21%)、次全切除者28例(71.79%)。全切除组患者新增脑神经损伤或原有脑神经损伤症状加重的发生率高于次全切除组[6例(6/11)对4例(14.29%),Fisher确切概率法:P=0.017],术后KPS评分低于次全切除组[(72.00±9.19)分对(82.69±10.41)分;t=-2.844,P=0.007];而两组肿瘤复发和(或)进展发生率差异无统计学意义(Fisher确切概率法:P=0.545)。次全切除组接受与不接受伽马刀治疗,肿瘤复发和(或)进展发生率差异无统计学意义(Fisher确切概率法:P=0.529)。结论岩斜区脑膜瘤经乙状窦后入路行次全切除术,术后辅助或不辅助伽马刀治疗均为可行治疗策略。