岩骨斜坡脑膜瘤的多样化治疗以及长期随访结果分析
PETROCLIVAL MENINGIOMAS: MULTIMODALITY TREATMENT AND OUTCOMES AT LONG-TERM FOLLOW-UP.岩骨斜坡脑膜瘤的多样化治疗以及长期随访结果分析
CLINICAL STUDIES
Neurosurgery. 60:965-981, June 2007.
Natarajan, eesh K. M.D., M.S.; Sekhar, Laligam N. M.D.; Schessel, David M.D., Ph.D.; Morita, Akio M.D., Ph.D.
Abstract:
OBJECTIVE: To evaluate patients' clinical outcome, survival, and performance status, at the long-term follow-up evaluation after aggressive microsurgical resection of petroclivaTl meningiomas.
目的：积极的显微外科手术切除岩骨斜坡脑膜瘤后，通过长期随访评价病人临床效果，生存和表现状态。
METHODS: During a 13-year period (1991-2004), 150 patients underwent 207 operative procedures for resection of petroclival meningiomas. The tumor size was large in 79% of the patients, with a mean tumor diameter of 3.44 cm. Tumors extended into adjoining regions in 57% of the patients. Thirty patients (20%) previously underwent operation or irradiation. One hundred patients (66%) had a single operation, 43 patients (29%) had two operations, and seven patients (5%) had three operations. Gross tumor resection was accomplished in 48 patients (32%), subtotal resection in 65 patients (43%), and partial resection in 37 patients (25%). There were no operative deaths. Postoperative complications (cerebrospinal fluid leakage, quadriparesis, infections, cranial nerve palsies, etc.) were observed in 33 patients (22%). Postoperative radiation or radiosurgery was administered to 47 of the 102 patients who had residual tumors. The outcome and survival of patients were evaluated by questionnaires, telephone calls, and review of their recent radiological images.
方法：在13年的时间里（1991-2004），研究150例经岩骨斜坡脑膜瘤切除术病人，他们共经历了207次手术。79%的病人肿瘤体积较大，平均直径达到3.44CM。57%的病人肿瘤浸润到临近组织。20%的病人以前接受过手术或者放疗。100例病人（66%）只受过一次手术，43例病人（29%）接受过两次手术，7例病人（5%）经历过3次手术。48例（32%）病人施行了肿瘤全切除，65例（43%）病人接受了肿瘤次全切除，37例（25%）施行肿瘤部分切除。无手术死亡病例。33例（22%）出现术后并发症（包括脑脊液漏、四肢瘫、感染、颅神经麻痹等）。102例未进行全切的肿瘤病人中其中47例接受术后放疗。我们通过问卷调查，电话和他们近期的放射学影像对存活病人生存情况进行评估。
RESULTS: At the conclusion of the study, 87 patients (58%) were alive with disease and 45 patients (30%) were alive without disease. The mean follow-up period was 102 months (range, 15-180 mo). Seven patients (5%; five of the subtotal and partially resected patients and two of the total resection patients) had recurrence; of these patients, two underwent repeat resection and four were treated with gamma knife radiosurgery. One of the patients died of tumor progression with no response to gamma knife radiosurgery. The recurrence-free survival rate was 100% at 3 years, 92.7% at 7 years, and 85% at 12 years; the progression-free survival rate was 96% at 3 years, 86.8% at 7 years, and 79.5% at 12 years. The Karnofsky Performance Scale score was 78 +/- 11 preoperatively, 76 +/- 11 at 1 year postoperatively, and 84 +/- 9 at the time of the latest follow-up evaluation. Common disabilities at the time of the follow-up evaluation included diplopia, loss of hearing, balance problems, and loss of sensation in the V1 and V2 cranial nerve distribution. Most patients developed coping mechanisms.
结果：研究结果表明，87例病人（58%）带病生存，45例（30%）健康生存。平均随访时间达102月。7例病人（5例次全和部分切除，2例全切除）复发。在复发病人中，2例行再次切除，4例行伽马刀治疗，1例由于肿瘤进展且多伽马刀治疗不敏感而死亡。未复发比率达到3年100%，7年92.7%，12年85%。肿瘤未进展率3年96%，7年86.8%，12年79.5%。卡氏评分术前78±11，术后一年76±11，在最近的随访评估中84±9.在随访中发现一些常见的残疾包括复视，听力丧失，平衡问题，三叉神经眼支和上颌支感觉障碍。大多数病人应对能力得到好转。
CONCLUSION: This series has the largest number of patients with the longest follow-up period, to our knowledge, reported in the literature to date. The excellent quality of life at the time of the long-term follow-up examination for these patients warrants aggressive but judicious tumor resection, with or without radiosurgical treatment of tumor remnants.
结论：本次研究为有文献报道以来，随访病人数量最多，时间最长的研究。经过长期的随访发现，积极而果断的肿瘤切除，并可选择性辅以术后对残存肿瘤组织的放疗，病人可以获得很好的生存质量。
页:
[1]
