伴有癫痫的脑膜瘤22例治疗分析

目的总结伴有癫痫的脑膜瘤的手术治疗及其效果。方法选自2008年6月至2010年6月入住本院并且行手术治疗的22例伴有癫痫的脑膜瘤患者,术前均行影像学检查及神经电生理检查。结果手术达到SimpsonⅠ、Ⅱ级切除的有16例,达到SimpsonⅢ级切除的有3例,达到SimpsonⅣ级切除的有4例。达到SimpsonⅠ、Ⅱ级切除的16例患者术后复查脑电图表明其中5人脑电图正常,5人脑电图轻度异常,6人中度异常,较术前明最改善。术后3个月以上的随访发现,达到SimpsonⅠ、Ⅱ级切除的16例患者中14例癫痫基本消失,手术有效率为87．5％。结论脑膜瘤合并癫痫患者治疗上应以肿瘤切除为主,辅以抗癫痫药物。能够做到SimpsonⅠ、Ⅱ级切除的患者癫痫能够得到良好的控制。     

矢状窦、镰旁脑膜瘤显微手术治疗(附28例报告)

目的探讨矢状窦、镰旁脑膜瘤显微手术治疗策略和疗效。方法 28例矢状窦、镰旁脑膜瘤患者行显微手术治疗,并进行回顾性总结,分析临床表现、影像学改变、显微手术及其疗效。结果按照Simpson切除分级标准,Ⅰ级切除12例,Ⅱ级切除16例,无手术后死亡病例。随访0.5～6年,5例复发。结论显微外科技术治疗矢状窦、镰旁脑膜瘤是一种安全有效的方法,争取SimpsonⅠ级切除是预防脑膜瘤术后复发的有效措施。     

显微外科手术治疗颅内脑膜瘤疗效分析

目的分析颅内脑膜瘤显微外科治疗效果并总结手术治疗经验。方法回顾性分析2017年7月～2020年1月我科采用显微外科手术治疗的31例脑膜瘤患者的临床资料,其中嗅沟脑膜瘤3例,窦镰旁脑膜瘤8例,蝶骨嵴脑膜瘤5例,脑室内脑膜瘤3例,大脑凸面脑膜瘤10例,后颅凹脑膜瘤2例;肿瘤直径平均3.5(2～6)cm。结果本组31例手术切除程度分级:SimpsonⅠ级18例(58.06%),SimpsonⅡ级8例(25.81%),SimpsonⅢ级3例(9.68%),SimpsonⅣ/Ⅴ级2例(6.45%);术后功能状态Karnofsky(KPS)评分:100分23例,90分5例,80分2例,70分1例。术后颅内感染4例,予抗生素联合腰大池脑脊液持续外引流,皆治愈出院,未遗留严重并发症。术后一过性视力下降1例,予以改善循环营养神经药物应用后症状消失。29例随访2月～2年,均未见复发。结论术前详细的影像学检查,术中妥善处理受累血管,保护好重要的引流静脉和功能区脑组织是提高颅内脑膜瘤显微外科手术治疗效果、减少并发症的关键。     

蝶骨嵴脑膜瘤的显微手术术后生活质量分析

目的 探讨蝶骨嵴脑膜瘤的显微手术方法对术后生活质量的影响。方法 选取50例蝶骨嵴脑膜瘤者且给予相应显微手术,对手术情况和患者生活质量等内容进行观察与分析。结果 50例蝶骨嵴脑膜瘤者Simpson Ⅰ级全切除率为56.00％、Simpson Ⅱ级全切除率为30.00％且患者术后生活质量与术前相比明显改善（p<0.05）。结论 显微手术治疗蝶骨嵴脑膜瘤可显著提高患者生活质量     

显微手术治疗小脑幕脑膜瘤的临床效果观察与分析

目的观察与分析显微手术治疗小脑幕脑膜瘤的效果。方法选取30例小脑幕脑膜瘤患者且给予显微手术治疗措施,同时对其进行观察,然后对所得数据进行统计学处理与分析。结果此次显微手术SimpsonⅠ级全切除率为16.67%、SimpsonⅡ级全切除率为56.67%且手术前后生活质量评分相比存在明显差异有统计学意义(P<0.05)。结论显微手术治疗小脑幕脑膜瘤效果显著。     

巨大脑膜瘤显微手术治疗

目的探讨巨大富血管脑膜瘤显微手术切除疗效与技巧. 方法回顾性分析我院1999年6月～2002年6月32例巨大富血管脑膜瘤的临床资料. 结果脑膜瘤切除按Simpson分级,1级15例,2级9例,3级6例,4级2例.死亡2例.并发症:术后继发颅内血肿4例,脑水肿及梗死6例(再次手术减压4例),缄默症1例,脑脊液漏3例,颅内感染1例.神经功能损害或症状较术前加重7例.30例随访6～48个月,平均24.6月, Simpson 1级切除无复发,Simpson 2级切除4例复发,Simpson 3、4级切除5例复发,再次手术切除肿瘤6例.7例放射治疗随访期内肿瘤均无明显增大.术后日常生活能力量表(activity of daily living, ADL)评估神经功能障碍,Ⅰ级25例,Ⅱ级5例,Ⅲ级2例,术前后ADL评分无显著性差异(P=0.696). 结论脑膜瘤手术治疗应力争全切除.充分的术前准备,良好的手术暴露,有效地控制术中出血,分块切除肿瘤,利用显微技术仔细分离瘤壁,是提高手术疗效的关键.     

CT表现为非典型性非恶性脑膜瘤的病理学探讨

我们对45例CT表现为非典型病理诊断为非恶性的脑膜瘤，采用细胞核仁组成区嗜银蛋白技术进行观察。结果表明．其中48．9%的Ⅱ级脑膜瘤（WHO）分级）虽非恶性，但细胞核仁组成区嗜银蛋白的数量、大小分布及异常形态变化与Ⅰ级者有明显差异，两者呈直线相关关系。提示CT表现为非典型性Ⅱ级脑膜瘤有明显的潜在增殖能力。推断可藉此预测CT表现为非典型性非恶性脑膜瘤的复发机率。     

上矢状窦旁镰旁中1/3脑膜瘤的显微外科治疗

目的 探讨上矢状窦旁镰旁中1/3脑膜瘤的手术策略,提高肿瘤切除率和手术效果.方法 对5年内手术治疗74例上矢状窦旁镰旁中1/3脑膜瘤进行了回顾性研究,分析了临床、影像学和手术资料,并对患者进行了随访.结果 74例中,SimpsonⅡ级切除67例,Simpson Ⅲ级切除7例,没有SimpsonⅠ级切除.术中所有病例矢状窦及中央沟静脉保护完好,皮层供血血管未损伤.肿瘤囊内分块切除的66例病例(Simpson Ⅱ级切除61例,Simpson Ⅲ级切除5例),术后患者对侧下肢肌力正常或短暂的力弱.肿瘤翻转并分块切除8例病例(Simpson Ⅱ级切除6例,SimpsonⅢ级切除2例),1例对侧下肢完全性瘫痪,7例病例术后患者对侧下肢肌力正常或短暂的力弱.随访6个月～4年2个月,失访4例,未见肿瘤复发,手术后对侧下肢力弱的病例1个月后功能恢复正常,手术后对侧下肢完全性瘫痪的1例病例6个月后肌力恢复到Ⅳ级.无死亡病例.结论 显微镜下肿瘤分块切除、保护好中央静脉、处理好矢状窦、避免脑皮质损伤是提高肿瘤切除率、保护神经功能的最佳方法.     

嗅沟脑膜瘤的显微外科手术治疗21例临床分析

目的 报道嗅沟脑膜瘤显微外科手术治疗的临床疗效.方法 回顾性分析显微手术治疗嗅沟脑膜瘤21例的临床和随访资料,对嗅沟脑膜瘤的显微手术技巧和颅底重建方法进行探讨. 结果 21例脑膜瘤显微手术,Simpson Ⅰ级全切除19例(90.5%),SimpsonⅡ级全切除2例(9.5%).术前视力变差的15例,术后视力改善14例,术后视力无改善1例:术后无脑脊液漏发生,Simpson Ⅰ级全切除的病例术后平均随访30个月未见肿瘤复发. 结论 应用显微外科手术全切除嗅沟脑膜瘤和严密的颅底重建,能够取得较好的临床疗效.     

镰旁脑膜瘤的显微手术治疗

目的探讨镰旁脑膜瘤的显微手术治疗方法 ,提高镰旁脑膜瘤的治疗效果。方法回顾性总结分析45例镰旁脑膜瘤的临床资料和显微手术治疗效果。结果肿瘤切除程度按S impson分级标准进行判定:45例患者中有42例为Ⅰ~Ⅱ级切除,3例为Ⅲ级切除,无手术死亡。随访6月~5年,全部病人均恢复正常生活,均无复发。结论显微手术治疗镰旁脑膜瘤时,注意选择适当的手术入路以及显露和切除肿瘤的技巧,可提高肿瘤的全切率,减少严重并发症,提高手术疗效。     

Long-term survival analysis of atypical meningiomas: survival rates,prognostic factors,operative and radiotherapy treatment

Background

The rarity and the inconsistent criteria for defining atypical meningioma prior to the WHO 2007 classification made its management and prognostic factors poorly understood. Only few articles have addressed the survival rates of WHO-classified atypical meningiomas. The small number or the disproportionate representation of irradiated patients was a weakness for these articles. This study evaluated whether the extent of surgery and receiving adjuvant radiotherapy after an initial operation along with other patient characteristics influenced the recurrence and survival rates of atypical meningiomas.

Methods

The clinical and surgical notes of the 79 patients with grade II atypical meningioma treated at our center over 13 years were retrospectively evaluated. The histology grading was consistent with WHO 2007 classification. The Simpson grading system was used to assess the extent of surgical resection. Kaplan Meier analysis, Cox multivariate regression analysis, and the Log-rank test were conducted using STATA® statistical package.

Results

The average age at the time of initial operation was 58 years, and 54 % were males. The mean follow-up period was 50 months. In Cox multivariate analysis, only Simpson grading was predictive of recurrence (hazard ratio = 2.22 / 1 increase in Simpson grade. p?=?0.003). Simpson grade I patients had a relapse-free survival rate of 97 and 74 % at one and five years, respectively, compared with 88 and 32 % in the subtotal resection group (Simpson grades II to IV). There was no statistically significant correlation between recurrence and subjecting patients to postoperative radiotherapy. Apart from Simpson grade I patients, there was a general trend for worse outcome in irradiated patients.

Conclusions

The most important prognostic factor in determining recurrence was Simpson grading. There was no statistically significant impact of adjuvant radiotherapy on the recurrence of atypical meningiomas. Meta-analysis for the existing literature is needed.     

Prognostic value of allelic losses and telomerase activity in meningiomas

OBJECT: The goal of this study was to examine allelic losses and telomerase activity in meningiomas to determine whether they could be used to predict disease recurrence. METHODS: To identify predictive markers of recurrence, a cohort of high-grade (24 World Health Organization [WHO] Grade II and six WHO Grade III) and low-grade (21 WHO Grade I) meningiomas was investigated for losses of heterozygosity (LOHs) on chromosomes 1p, 9p, 10q, 14q, and 22q, a deletion of CDKN2A, and telomerase activity. Results of molecular analyses were compared with radiological and histological findings and progression-free survival (PFS). Losses of heterozygosity on chromosomes 22q, 1p, and 10q, as well as telomerase activity were related to the WHO histological grades of the lesions (p < 0.01, p < 10(-5), p < 10(-4), and p = 0.002, respectively). In the absence of an LOH on 22q, the other alterations were found infrequently. Overall, the number of molecular alterations was closely related to the histological grades of the lesions (p < 10(-6)). An LOH on 22q occurred much more frequently in convexity or falx (33 [87%] of 38 lesions) than in skull base or spinal meningiomas (four [31%] of 13 lesions) (p < 0.001). The histological grade; Simpson grade; an LOH on chromosome 1p, 9p, or 10q; and telomerase activity were correlated with a shorter PFS time (p < 10(-4), p = 0.02, p = 0.000365, p = 0.022, p = 0.00027, and p = 0.000512, respectively). CONCLUSIONS: On the basis of these data the authors suggest that LOH analysis and a telomerase activity assay could be useful to determine molecular predictors of outcome in patients with meningiomas.     

Clinical features,radiological findings,and treatment outcomes of high-grade lateral ventricular meningiomas: a report of 26 cases

High-grade meningiomas in ventricles are rare, where most published series only include a few patients. A retrospective analysis was performed on the clinical features, radiological findings, and treatment outcomes of 26 patients with high-grade meningiomas in lateral ventricles who were surgically treated in our hospital between July 2008 and July 2016. A female predilection (female/male = 1.4:1) was observed with a mean age of 42.4 years. Headache and/or vomiting (65.3%) were the most common initial symptom, and with symptom duration time ranging between 7 days and 5 years (mean 8.5 months). The lateral ventricle trigone area was the most common site (80.7%). Twenty-two patients (84.6%) obtained gross total resection. The 2007 WHO classification was used to classify 22 (84.6%) meningiomas as grade II and the remaining four tumors were graded III. These tumors accounted for a recurrence rate of 38.5% (10 of 26 patients) and a mortality rate of 11.5% (3 deaths) during the follow-up periods. The recurrence rate after the gross total resection was 27.3% (6 of 22 patients). Radiotherapy was administered as an adjuvant treatment in 12 patients (46.2%) after surgery. There were 4 recurrences out of the 12 patients who received radiotherapy and 6 of the 14 patients relapsed without radiotherapy (p = 0.58). The subtotal resection was considered a risk factor for recurrence. The postoperative radiotherapy seemed to have little significance for the high-grade meningiomas in the lateral ventricles. Long-term follow-up is required, regardless of the resection grade, and reoperation is feasible for patients with recurrence.     

Tentorial meningiomas: follow-up review

Tentorial meningiomas comprise 3-5% of the intracranial meningiomas. Different locations and sinus invasion require special surgical skills. This study aimed to analyze factors influencing the outcome of 29 patients (30 tumors) with tentorial meningiomas surgically treated. The study included 22 female and seven male patients, with age of 18-76 years old, and a follow-up of 6-179 months. Eight tumors were located on the inner tentorial ring, 15 on the outer ring, four were falcotentorial, and three attached/invading the torcula. Outcome was analyzed using survival and recurrence-free survival (RFS) curves. Twenty-seven tumors were WHO grade I and three were grades II-III. Total and subtotal resections were reached in 87.5% and 12.5% of tumors. Survival was better for patients with grade I tumors and similar according to sex, location, size, and extent of resection. Recurrence/regrowing rate was 12.5%. RFS curves were better for patients with grade I or with radical resection and similar according to sex, location, and size. There was no operative mortality. Permanent postoperative cranial nerve deficits occurred in 9.7% (all inner ring tumors). Despite being many times large-sized, surgical treatment of tentorial meningiomas gives good results. Prognostic factors for recurrence were histopathologic grade III and subtotal resection. Radical resection allowed better results. Nevertheless, subtotal resection may be acceptable for cases with cranial nerves or sinuses invasions.     

Clinical features and long-term outcomes of pediatric intraventricular meningiomas: data from a single neurosurgical center

The purpose of this study is to investigate the clinical characteristics and long-term outcomes of pediatric patients with intraventricular meningioma. We retrospectively analyzed a total of 30 pediatric patients with intraventricular meningiomas who were surgically treated at our department between January 2005 and June 2016 and analyzed their clinical characteristics and surgical outcomes. Among the 160 pediatric patients with intracranial meningioma, 33 (20.6%) had intraventricular lesions. However, only 30 patients had complete demographic and clinical data. A male predilection (male/female = 1.5:1) was observed, and the mean age of our patient cohort was 12.6 years. The lateral ventricle was the most common lesion site (88.6%). In addition, the most common initial symptom was headache or dizziness, and the average interval from symptom onset to admission was 19.17 months (0.25–72 months). Twenty-six patients (86.7%) achieved a Simpson grade of I. Based on the WHO classification, 28 (93.3%) meningiomas were classified as grade I, and the remaining two cases were grades II and III. During the follow-up period (0.67–10.08 years), 3 patients experienced tumor recurrence (15, 18, and 83 months, respectively), and 1 patient died of recurrence. Pediatric and adult intraventricular meningiomas present similar clinical characteristics and surgical outcomes; however, intraventricular meningiomas compose a higher percentage of pediatric meningiomas and have a male predilection. Compared with general pediatric meningiomas, pediatric intraventricular meningiomas tend to have higher incidence of benign subtypes. They are also more likely to be completely resected and have lower recurrence and mortality rates.     

人工智能制定乳腺癌术后治疗方案与相关指南一致性研究

目的 探讨人工智能对乳腺癌术后临床实践的指导意义，评估 Watson肿瘤解决方案（WFO）与美国国家综合癌症网络（NCCN）和中国抗癌协会乳腺癌治疗指南的一致性。方法 回顾性分析吉林大学中日联谊医院2016年1月至2017年12月期间实施手术后确诊为乳腺癌的100例病人资料，术后癌组织标本均采用免疫组化方法检测癌组织中雌激素受体（ER）、孕激素受体（PR）、人类表皮生长因子受体-2（HER-2）及Ki-67的表达水平，将该100例病人的相关临床资料录入到WFO系统中，并将其推荐治疗方案与NCCN及中国抗癌协会乳腺癌治疗指南进行对比，采用Kappa检验分析其一致性。结果 100例病人中共有64例（64%）治疗方案一致，其中临床分期为Ⅱ期（42/44，95.5%）～Ⅲ期（15/16，93.6%）及免疫组化分型为三阴性乳腺癌（7/8，87.5%）的治疗方案表现出较高的一致性（Kappa值≥0.75）；年龄≥41岁、免疫组化分型为Luminal A型及病理学分级为Ⅲ级的治疗方案也都具有一定的一致性，其中年龄41~55岁的病例的治疗方案一致性一般，而年龄＞55岁级及病理学分级为Ⅲ级的治疗方案一致性不理想；在年轻早期乳腺癌病人中，临床分期Ⅰ期（7/40，17.5%）、淋巴结转移癌为阴性的治疗方案很不一致（Kappa值＜0）；而年龄＜41岁、病理学分级为Ⅰ～Ⅱ级、免疫组化分型为Luminal B型及HER-2型的病例的治疗方案无统计学意义。结论 WFO在临床分期Ⅱ～Ⅲ期及免疫分型为三阴性乳腺癌（P＜0.05）病人中具有较高的参考价值；在年龄≥41岁、分子分型为Luminal A型、病理学分级为Ⅲ级的病人可考虑使用；对临床分期Ⅰ期的早期乳腺癌病人不推荐使用。WFO对部分病人可给出合理的治疗建议，能为临床医生提供临床决策支持，在乳腺癌术后临床实践方面及临床学习和研究中具有一定的指导意义。     

Optimal surgical strategy for meningiomas involving the superior sagittal sinus: a systematic review

Involvement of the superior sagittal sinus (SSS) by meningiomas poses specific challenges, without an agreement about the degree of surgical aggressiveness when dealing with these lesions. In this systematic review and meta-analysis, we compare outcomes and complication rates, after different surgical strategies. Studies focused on meningiomas involving the SSS were collected from numerous online databases. Surgical outcome and complication data were abstracted. Comparisons were made considering complication and recurrence rates between an “aggressive” and a “non-aggressive” surgical attitude. A total of 26 studies, encompassing 1614 patients, were identified. Most of the tumors (53%) arose from the middle third of SSS and 75% of patients had a patent sinus at the time of surgery. A favorable outcome was achieved in 73% of patients treated with an “aggressive” surgical attitude compared to 78% of patients treated with a “non-aggressive” surgical attitude. Complication rates were similar between “aggressive” and “non-aggressive” attitudes, except for a higher rate of venous infarct (4% versus 2%, respectively) and worsening of preexisting motor deficits (34% versus 13%, respectively) in aggressively treated patients. Recurrence rates were not substantially different in the two groups after accounting for length of follow-up. Patients with incomplete resection (Simpson grades II–V) or with high histological grade (WHO grade III) had significantly higher recurrence rates. A complete resection achieves higher rates of tumor control, however, without nullifying the risk of recurrence. Moreover, “aggressive” tumor removal is associated with higher rates of venous complications and worsening of preexisting motor deficits.

     

The influence of age on the histological grading of meningiomas

This study was undertaken to assess the relationship between the age of patients at the time of their surgery and histological grading of meningiomas. A retrospective review was conducted for 1,083 consecutive patients with meningiomas who had surgical removal between January 1991 and December 2006. Histological grading for each tumor was done utilizing the WHO classification for meningiomas. The incidence of WHO grade II or III tumors between the elderly and the non-elderly groups was compared. The mean age at diagnosis for the WHO grade I, II, and III tumors was 55.1 (±14.79), 59.0 (±15.54), and 64.3 years (±13.28) (p value?=?0.007), respectively. We found that 11.9 % of meningiomas diagnosed after the age of 60 years was WHO grade II or III, while this value was only 6.9 % for patients 60 years or younger (p?=?0.0006). Our study showed that the combined incidence of WHO grade II and III meningiomas increases as age advances. We believe that this constitutes an important piece of information requiring neurosurgeons to carefully and continuously observe the elderly patients harboring meningiomas.     

神经内镜辅助眶上锁孔入路切除鞍结节脑膜瘤

目的总结内镜辅助下经眶上锁孔入路显微手术切除鞍结节脑膜瘤的手术效果。方法13例鞍结节脑膜瘤采用眶上锁孔入路,先在显微镜直视下切除部分肿瘤,再在内镜辅助下切除残余肿瘤。结果肿瘤全切除12例（SimpsonⅠ级切除2例,Ⅱ级切除10例）,次全切除1例（SimpsonⅢ级切除）。11例术后随访3个月～6年,平均2.3年,〈1年恢复正常工作和生活9例,术后2年肿瘤复发1例,1年后恢复生活自理1例。结论内镜辅助下眶上锁孔入路切除鞍结节脑膜瘤克服了显微镜直视下的盲区,并发症少,创伤小,效果满意。     

Sphenoid wing meningiomas with osseous involvement

BACKGROUND: Sphenoid wing meningiomas (SWMs) with osseous involvement are neurosurgically challenging because of their position within the skull base and their high rates of recurrence. Sufficient resection of these meningiomas requires extensive surgical exposure. We report on 82 patients with meningiomas infiltrating the sphenoid wing, analyzing radiological appearance and its influence on surgical management. METHODS: Charts of the patients including surgical records, clinical reports, histological examinations, imaging studies, and meticulously focusing questionnaires were reviewed. RESULTS: Among the 82 patients with osseous-involved SWMs, the mean age was 52.2 years in the female group and 54.7 years in the male group with a mean follow-up of 66.23 months (24-206). Histological evaluation revealed World Health Organization grade I meningiomas in 94% of case patients, tumor infiltration of examined bone in all case patients, and proliferation rates of 2.2% Ki-67. Magnetic resonance imaging appearance of the SWMs demonstrated various densities as well as Gd enhancement within the affected bone. Recurrence rates in this subgroup of SWMs are higher (>30%) compared with meningiomas without osseous involvement (11.6%). CONCLUSION: Osseous involvement in SWMs accounts for lower resection and higher recurrence rates than meningiomas in other locations. In those cases with involvement of the cavernous sinus, a subtotal but extensive removal combined with bony decompression of the cranial nerves at the superior orbital fissure and optic canal frequently produces good functional and cosmetic results.