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。     

脑膜瘤术后复发的影响因素

脑膜瘤是颅内常见肿瘤,其发病率仅次于胶质瘤。脑膜瘤的治疗仍以手术为主。但即使实行最严格的手术切除,脑膜瘤术后复发率仍然较高,而且复发瘤的恶性程度亦往往提高。即便良性原发瘤,复发时也会有一定比例的恶性变。本文仅就近年来有关探讨脑膜瘤术后复发的影响因素作一回顾,并讨论相应的减少脑膜瘤复发的注意事项。1 脑膜瘤生物学特性对脑膜瘤复发的影响1.1 组织学特性的影响 1993年世界卫生组织(WHO)提出对脑膜瘤进行组织学分类的新方法,依     

脑膜瘤术后复发相关因素的研讨

脑膜瘤是颅内常见的肿瘤,占颅内肿瘤的13.4%~25.0%,绝大多数脑膜瘤属良性,生长缓慢,包膜完整,大多数可切除,但是良性脑膜瘤全切术后的复发率仍高达9%~22%。本文总结我院1982~1993年收治的150例脑膜瘤对全切术后105例复发12例的复发原因加以分析,并提出防治意见。     

非典型脑膜瘤和良性脑膜瘤术后复发危险因素的初步分析

目的比较非典型脑膜瘤和良性脑膜瘤术后复发的影响因素。方法 442例脑膜瘤患者按照病理诊断结果分为良性脑膜瘤组415例及非典型脑膜瘤组27例,比较两组患者临床病理特征,并采用单因素分析法及多因素Logistic回归分析法分析两组患者术后复发的危险因素。结果与良性脑膜瘤组比较,非典型脑膜瘤组的肿瘤直径5 cm,肿瘤边界不清,手术非全切,术后放疗及术后复发患者更多。非典型脑膜瘤组的单因素分析发现,肿瘤大小(P=0.002)和手术切除程度(P=0.032)对其术后复发有显著影响。多因素Logistic回归分析结果显示肿瘤全切(OR=0.034,95%CI:0.003~0.399,P=0.007)是非典型脑膜瘤术后复发的唯一保护因素。良性脑膜瘤组单因素分析显示肿瘤大小,边界和手术切除程度对术后复发有显著影响(均P=0.000);多因素分析发现肿瘤最大直径5 cm(OR=14.916,95%CI:5.384~41.329,P=0.000)是良性脑膜瘤术后复发的危险因素,肿瘤边界清楚(OR=0.184,95%CI:0.075~0.453,P=0.000)和肿瘤全切(OR=0.034,95%CI:0.012~0.095,P=0.000)均是良性脑膜瘤术后复发的保护因素。结论手术非全切是非典型脑膜瘤术后复发的危险因素。良性脑膜瘤术后复发的危险因素包括肿瘤最大直径5 cm、肿瘤边界不清和非全切除。     

侧脑室三角区脑膜瘤术后恶性变1例

1病历资料女,47岁。2年前无明显诱因出现间歇性头痛,逐渐加重,进而出现右眼视物模糊,右耳耳鸣,左腿一过性无力。体格检查:神志清楚,一般状态良好,颅神经未见明显异常,左下肢肌力Ⅱ级。CT见右侧脑室三角区圆形占位,均匀一致略高密度影,CT值38Hu,大小4.5cm×3.5cm,无钙化,边缘清楚,周围可见低密度水肿带,右侧侧脑室受压闭塞,考虑脑膜瘤可能性大(图1A)。行右侧顶枕入路肿瘤切除术,术中打开侧脑室三角区,见肿瘤与正常脑组织分界明显,质地较软,显微镜下完全切除肿瘤。病理报告为内皮性脑膜瘤,细胞排列紧密,胞核圆形,染色质细而少,胞浆丰富,可…     

间变性脑膜瘤15年后复发为乳头状样脑膜瘤1例

1 病例资料 44岁女性,因左下肢肌力减弱2个月于2019年6月19日就诊于南昌大学附属人民医院神经外科.2004年5月因额顶区脑膜瘤,行脑膜瘤全切除术,部分颞极被切,术后病理结果示间变性脑膜瘤,出院时左上肢肌力3级,左下肢肌力5级,肌张力正常.门诊接受放疗1个月,症状改善,左上肢肌力稍差,生活可自理.2017年复查头...     

第四脑室脑膜瘤1例报道并文献复习

1病历摘要女,46岁。突发眩晕入院,查体示轻微步态不稳,单足闭目难立征阳性,左侧明显。MRI检查提示：第四脑室偏左见一边界清楚长T1、长T2异常信号影,扫描实性部分强化明显（图1）。采取枕下后正中入路切除肿瘤,在第四脑室左外侧中下段见肿瘤与小脑中脚、下脚、小脑蚓部脑室面黏连,易于分离,肿瘤起源于第四脑室左侧脉络丛组织。术后病理提示脑膜瘤WHOⅠ级（图1C、1D）。     

脑膜瘤Nestin表达与术后复发的关系

目的 探讨巢蛋白（Nestin）在脑膜瘤中的表达情况,分析其与脑膜瘤术后复发的关系。方法 收集2015年9月～2017年9月手术切除的169例脑膜瘤的肿瘤标本,采用免疫组化染色法检测肿瘤组织Nestin的表达水平。术后随访4年,采用多因素logistic回归模型分析脑膜瘤术后复发的危险因素。结果 169例中,术后复发43例,复发率为25.44%。169例脑膜瘤Nestin阳性表达率为73.37%(124/169),其中WHO分级Ⅰ级脑膜瘤Nestin阳性表达率[50.94%(27/53)]明显低于Ⅱ级、Ⅲ级脑膜瘤[分别为80.90%(72/89)、92.59%(25/27);P<0.001]。多因素logistic回归分析显示,Nestin表达阳性是脑膜瘤术后复发的独立危险因素（P<0.05）。结论 脑膜瘤Nestin表达与肿瘤WHO分级有关,检测Nestin表达可用于评估脑膜瘤术后复发的风险。     

复发性脑膜瘤恶变第二次手术切除并术后放疗效果观察

脑膜瘤一般呈膨胀性生长．病程长．多数为良性。一般部位的脑膜瘤，只要入路选择恰当，显露均比较清楚，绝大多数均能全部切除而痊愈。但对于浸润性生长的脑膜瘤（尤其有恶变倾向者），术中稍有遗漏致瘤体残存．均可导致其复发。本文回顾分析了我院从2002年2月至2007年2月5例脑膜瘤复发的原因，第二次手术时行“0”级切除。术后放射治疗，取得满意效果。     

透明细胞型脑膜瘤6例报道并文献复习

目的 探讨透明细胞型脑膜瘤(Clear cell meningioma,CCM)临床、影像及病理学特征.方法 回顾性分析了2005年至2012年2月经手术及病理证实的6例透明细胞型脑膜瘤.结果 MRI表现为T1加权像信号不均匀者5例,呈类球形2例,分叶状型3例,扁平型1例;可见硬膜尾征者5例,黑环征不完整者或缺乏者5例,1例黑环征基本完整;轻度水肿4例,中、重度水肿各1例;瘤内、瘤周囊变各1例;肿瘤钙化2例.行Simpson Ⅰ级切除4例,Simpson Ⅱ级切除2例,术后1例34月后复发.病理学检查示水样透明细胞呈片状排列,细胞呈多边形,胞质透明,胞核居中,中间交织着透明变性的胶原.免疫组化显示上皮膜抗原EMA(+)、波形蛋白Vimentin(+),神经胶质纤维酸性蛋白GFAP(-)、S-100蛋白(-)、细胞角蛋白CK(-),同微囊型脑膜瘤、透明细胞型室管膜瘤、少突神经胶质瘤和透明细胞型转移癌等相鉴别.结论 透明细胞型脑膜瘤MRI表现多为信号不均匀,无黑环征或黑环征不完整,明确诊断主要依靠组织病理学检查,免疫组化有助于其鉴别诊断.CCM侵袭性较强,同良性脑膜瘤相比术后更易复发.     

Vascular endothelial growth factor and malignant transformation of a meningioma: Case report

Abstract

Although meningiomas are common benign intracranial tumors which grow slowly, we occasionally encountered aggressive or malignant ones. One of these cases showed an interesting relationship to vascular endothelial growth factor (VECF). A 39-year-old woman underwent resection of a sphenoid ridge meningioma; the residual tumor showed evidence of malignant transformation 14 years later. We immunohistochemically examined six successive surgical specimens plus the autopsy specimen of this patient’s tumor for proliferative potential, vascularity, and expression of various growth factors. In the latter stage of clinical courses, proliferative potential and vascularity was seen to increase year by year. Expression of VEGF was upregulated and correlated with vascularity. On the other hand, basic fibroblast growth factor (bFGF), platelet-derived growth factor (PDGF), and epidermal growth factor (EGF) were not overexpressed in this tumor. This case suggests that overexpression of VEGF and increased angiogenic potential might be involved in malignant transformation of meningiomas. [Neurol Res 2000; 22: 189-193]     

严重骨质破坏伴广泛性钙化的颅内多发脑膜瘤一例

正患者女性,62岁,主因右侧颞部骨性隆起进行性增大10年余,于2015年4月10日至天津市环湖医院就诊。患者10余年前无明显诱因出现右侧颞部骨性隆起,呈进行性增大,无压痛,触之不动,未予特殊处理。3 d前因右侧下颌腺炎于外院口腔科行口腔颌面部CT检查显示右侧额颞部占位性病变,无头痛、头晕,无肢体麻木、抽搐、无力等症状。     

侧脑室内胶质瘤与脑膜瘤的碰撞瘤一例并文献复习

目的 报告1例罕见的侧脑室内胶质瘤与脑膜瘤的碰撞瘤,并探讨其发生原因.方法 39岁男性,6年前曾行侧脑室内胶质瘤切除术;此次以头痛及头晕发病,MRI示胶质瘤原位复发,且同时合并另一占位性病变,予以手术切除.术后病理证实为胶质瘤与脑膜瘤的碰撞瘤;本文同时也对这种碰撞瘤进行文献复习.结果 术后患者恢复满意,并行伽玛刀放射治疗,随访1年时患者状态良好.本文在复习侧脑室内胶质瘤与脑膜瘤的碰撞瘤发生原因后,总结了几种假设.结论 复发的胶质瘤诱发脉络丛内的蛛网膜细胞恶性转化可能是导致脑膜瘤的原因,同时胶质瘤的刺激也可能诱导了脑膜瘤的生长.     

Meningioma following high-dose radiation therapy Case report and review of the literature

A case of meningioma induced by high-dose radiation therapy (40 Gy) is reported. The radiation had been given 11 years previously following operation for cerebral astrocytoma. Pertinent cases of benign meningioma occurring after radiation therapy are reviewed and analyzed.     

Late malignant transformation of anaplastic meningioma 18 years after primary surgery: A case report

Meningiomas rarely progress to malignant variants and there is no consensus regarding the period over which malignant transformation may occur. Here, we report a case of anaplastic meningioma that showed malignant transformation 18 years after gross total resection of benign meningioma in the primary surgery, which may be the longest duration reported to date. Although the recurrence rate is low following total resection of benign meningioma, malignant transformation can rarely occur after a long period as in our case. Long-term follow-up after total resection of benign meningioma is suggested considering the risk of malignant transformation.     

Deep sylvian meningioma: a case report and review of literature

Case report  A 6-year-old boy presented with seizures. Computed tomography and magnetic resonance imaging showed a large enhancing mass in the left temporo-parietal region. Treatment  He underwent left temporo-parietal craniotomy and total excision of the lesion. At surgery, there was no dural attachment, and the tumor was mainly in the posterior part of left sylvian fissure. The biopsy was reported as WHO grade I meningioma. Outcome  At 4-year follow-up, he was asymptomatic, and there was no tumor recurrence.     

颅内转移性恶性黑色素瘤:一例报告并文献复习

目的探讨颅内转移性恶性黑色素瘤临床组织病理学及免疫组织化学特征。方法应用组织病理学及免疫组织化学检测方法对1例颅内多发转移性恶性黑色素瘤患者的两次手术标本进行观察,通过复习文献分析其组织病理学和免疫组织化学特征,提出诊断与鉴别诊断要点。结果男性患者,48岁。因颅内多发占位性病变、肿瘤卒中而行右侧额颞叶肿瘤切除术。两次手术标本组织病理学表现不一:首次右侧额叶病灶表现为异型性上皮样肿瘤细胞围绕毛细血管和纤维组织呈乳头状排列;再次手术标本为右侧颞叶,病灶表现为梭形细胞呈片巢状或束状排列,胞质丰富、淡染或透亮,胞核异型性明显、核仁呈明显嗜酸性。左侧腹股沟淋巴结活检提示肿瘤转移,且肿瘤组织局部可见大量黑色素颗粒。免疫组织化学染色肿瘤细胞弥漫表达S-100蛋白、人黑色素细胞瘤抗原45、Melan-A和波形蛋白,部分表达上皮膜抗原,而细胞角蛋白、高分子角蛋白、低分子角蛋白、胶质纤维酸性蛋白、突触素、神经微丝蛋白等表达阴性。结论颅内转移性恶性黑色素瘤的组织学表现复杂多样,临床病史和影像学资料对诊断具有重要参考价值,但明确诊断仍需依靠免疫组织化学检测结果。需注意与转移癌、脑膜肿瘤、淋巴瘤及其他含黑色素的颅内肿瘤相鉴别。     

Evidence of recurrent atypical meningioma with rhabdoid transformation and expression of pyrogenic cytokines in a child presenting with a marked acute-phase response: case report and review of the literature

Children presenting with acute systemic illnesses that lack specific clinical or serological defining features may be diagnosed as having a chronic infection, an atypical systemic vasculitis or a connective tissue disease, but often turn out to have occult neoplasias. Cytokines have been implicated in causing many of the systemic effects in such cases. In this study, we describe the case of a 9-year-old boy presenting at an interval of 18 months with a marked acute-phase response due to a recurrent atypical meningioma with rhabdoid transformation of the tentorium cerebelli. Resection of the recurrent tumor was curative. We evaluated in detail the local and systemic production of cytokines released by the primary and the recurrent tumor. Blood and CSF samples were taken pre-, intra-, and postoperatively, and the production of IL-6, IL-1β, and TNF- was measured by enzyme-linked immunosorbent assays (ELISA). The level of IL-6 in CSF was about 150-fold increased before tumor resection, normalizing postoperatively. On the contrary, the levels of IL-1β and TNF- in CSF and of IL-6, IL-1β, and TNF- in serum were pre-, intra-, and postoperatively within normal limits. Cytokine production was also evaluated immunohistochemically, and confirmed strong IL-6 and TNF- expression in the primary and the recurrent tumor, while expression of IL-1β was lacking. The scattered MHC class II- and leukocyte common antigen (LCA)-expressing inflammatory cells, which were infiltrating exclusively the tumoral stroma, had no detectable cytokine immunoreactivity. We conclude that chronic IL-6 and TNF- production by the tumor cells in this patient was responsible for the severe systemic illness with which he presented.     

基底动脉动脉瘤合并胚胎型大脑后动脉自发性闭塞的诊治分析(附1例报道并文献复习)

目的 总结基底动脉动脉瘤合并胚胎型大脑后动脉（FPCA）自发性闭塞致枕叶梗死的诊治经验,以提高此类疾病的认识,避免将FPCA残端误诊为动脉瘤。方法 回顾性分析1例基底动脉动脉瘤合并FPCA自发性闭塞致枕叶梗死的临床资料。结果 病人以突发右上肢麻木及视物模糊起病,外院DWI显示左侧枕叶内侧面梗死伴左侧丘脑灶样梗死,外院头颈部CTA示左侧颈内动脉后交通动脉动脉瘤（呈梭形）、基底动脉动脉瘤以及颅内多发血管硬化狭窄。我院左侧颈内动脉造影见左侧后交通动脉闭塞残端,残端远端可见中断后又部分显影,左侧大脑后动脉P1、P2均闭塞,椎动脉造影未见P1段发育,基底动脉中段动脉瘤。结合病人DWI梗死部位及术前灌注成像所示灌注失代偿区,考虑为左侧FPCA急性闭塞引起同侧枕叶梗死,CTA所谓的“梭样动脉瘤”其实为闭塞后的残端。采用双支架套叠辅助弹簧圈栓塞治疗基底动脉中段动脉瘤,出院时改良Rankin量表评分1分。结论 FPCA自发性闭塞临床极其罕见,急性闭塞后是否行血管内治疗依然存在争议;应加强对其影像学特征的认识和了解,以避免将其闭塞后残端误当做动脉瘤。