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Results with judicious modern neurosurgical management of parasagittal and falcine meningiomas. Clinical article

moviecapture 添加于 2011-4-27 00:41 | 977 次阅读 | 0 个评论

作者
Sughrue ME, Rutkowski MJ, Shangari G, Parsa AT, Berger MS, McDermott MW
摘要
OBJECT: The management of parasagittal and falcine meningiomas centers around the relationship between the tumor and the venous anatomy of the superior sagittal sinus (SSS) and the bridging veins. The present study aims to address surgical outcomes in a focused cohort of these patients for which there is not clinical equipoise between radiosurgery and transcranial resection. METHODS: The clinical outcomes of patients undergoing surgical removal of parasagittal and falcine meningiomas at the authors' institution over an 18-year period were analyzed. Analysis was limited to patients with large, symptomatic, or rapidly growing tumors, for whom radiosurgery was not a good option. Tumor control was assessed using Kaplan-Meier analysis, and specific attention was paid to the relationship between the tumor and the SSS, and its impact on tumor control and outcome. RESULTS: The authors identified 135 patients with large, symptomatic, and/or growing parasagittal/falcine meningiomas who underwent resection at their institution between 1991 and 2007. The median length of follow-up was 7.6 years (range 1.7-18.6 years). The SSS was found to be invaded in 61 of 135 cases. In 6 cases the sinus was completely occluded. In 33 of the remaining 55 cases, the tumor invading the sinus was able to be removed with simple microsurgical techniques. There was no difference in rates of tumor control in patients who received subtotal resection for a WHO Grade I tumor, followed by close observation, compared with those undergoing gross-total resection, primarily because no cases were observed in which the tumor remnant in the SSS demonstrated interval growth on serial imaging studies. Of the patients in this series, 19% experienced at least one neurological, medical, or surgical complication. CONCLUSIONS: Importantly, these data provide a more modern estimate of the expected outcomes that can be obtained with treatment of these tumors, in which a combination of image guidance, advanced microsurgical tools, and conformal radiation treatments is used.
详细资料
- 文献种类:期刊
- 期刊名称: Journal of Neurosurgery
- 期刊缩写: J Neurosurg
- 期卷页: 2011年第114卷第3期 731-737页
- 地址: Brain Tumor Research Center, Department of Neurological Surgery, University of California, San Francisco, California, USA
- ISBN: 0022-3085
- 备注:PMID:20950085
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附件
Results with judicious modern neurosurgical management of parasagittal and falci
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