Background

Sphenoid wing meningiomas are a challenging surgical disease with relatively high perioperative morbidity. Most studies to date have focused on resection strategies as it relates to disease recurrence. Few have examined the optimal strategy as it relates to overall patient survival. We retrospectively reviewed our case series and evaluated extent of resection and perioperative stroke as it relates to all cause and disease-specific survival.

Patients/Methods

Ninety-four patients were included in the study. Demographics, clinical features, operative features and clinical course, and time to mortality evaluation were collected. Extent of resection (EOR) was defined as gross total (GTR, 100%), near total (NTR, ≥ 95%), and subtotal (STR, < 95%).

Results

The overall mean EOR was 94.5% with 70.2% of cases achieving GTR, 12.8% achieved NTR, and 17% achieved STR. Postoperative stroke only occurred with GTR or NTR (p = 0.041). Age alone was significant on Cox regression analysis for all cause mortality (p = 0.042, HR 1.054 [95% CI 1.002 – 1.109]). Postoperative stroke was associated with worse disease-specific mortality (p = 0.046, HR 23.337 [95% CI 1.052 – 517.782) with no impact from extent of resection (p = 0.258).

Conclusions

Although maximizing resection and minimizing recurrence is ideal, GTR or NTR confer a significantly higher stroke risk. Most patients do not die from their meningioma, as all cause mortality was associated only with age. However, perioperative stroke conferred decreased survival throughout follow up. This series demonstrates that an overly aggressive surgical philosophy negatively impacted disease specific survival.

中文翻译：

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蝶骨翼脑膜瘤病例系列 - 什么是最大安全切除？

背景

蝶骨翼脑膜瘤是一种具有挑战性的外科疾病，围手术期发病率相对较高。迄今为止，大多数研究都集中在切除策略上，因为它与疾病复发有关。很少有人研究过最佳策略，因为它关系到患者的总体生存率。我们回顾性地回顾了我们的病例系列，并评估了切除范围和围手术期卒中，因为它与所有原因和疾病特异性生存相关。

患者/方法

该研究包括 94 名患者。收集人口统计学、临床特征、手术特征和临床病程以及死亡评估时间。切除程度 (EOR) 定义为总切除范围 (GTR, 100%)、接近总切除范围 (NTR, ≥ 95%) 和小计切除范围 (STR, < 95%  )  。

结果

总体平均 EOR 为 94.5%，其中 70.2% 的病例实现 GTR，12.8% 实现 NTR，17% 实现 STR。术后卒中仅发生在 GTR 或 NTR 患者中 (p  =  0.041)。在全因死亡率的 Cox 回归分析中，仅年龄就具有显着性（p  =  0.042，HR 1.054 [95% CI 1.002 – 1.109]）。术后卒中与更差的疾病特异性死亡率相关（p  =  0.046，HR 23.337 [95% CI 1.052 – 517.782），而切除范围没有影响（p  =  0.258）。

结论

尽管最大化切除和最小化复发是理想的选择，但 GTR 或 NTR 会导致中风风险显着升高。大多数患者不会死于脑膜瘤，因为全因死亡率仅与年龄相关。然而，围手术期卒中导致整个随访期间的生存率降低。本系列文章表明，过度激进的手术理念会对疾病特异性生存产生负面影响。