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无脑膜附着的脑实质内或皮层下脑膜瘤的临床特点及手术(附4例临床报告及文献复习)

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目的探讨无脑膜附着的脑实质内或皮层下脑膜瘤的临床、影像学和组织病理学特征及手术疗效。方法回顾性分析2019年12月—2022年12月在海南省人民医院手术治疗的4例无脑膜附着脑膜瘤患者的临床特点,影像学和组织病理学特征,对手术处理原则、手术疗效及长期随访结果,结合文献进行总结。结果所有患者好发部位是额顶叶,3例囊实性。癫痫发作为术前、术后常见症状。三维核磁共振成像(MRI)示,肿瘤均位于脑内,术前MRI及术中、术后病理均证实无硬脑膜附着。4例患者全切,2例WHO Ⅰ级,2例WHO Ⅱ级,1例不典型性脑膜瘤术后复发,1例术后无放疗,3例术后行放疗。平均随访1.5年,存活3例。结论无脑膜附着的脑实质内或皮层下脑膜瘤术前容易被误诊,部分皮层下或脑实质内脑膜瘤的瘤周水肿严重发生在病变附着于周围脑组织的区域,并非包围整个肿瘤表面,MRI波谱等特征可能有助于鉴别。WHO Ⅱ级非典型脑膜瘤其增殖率高,侵犯脑实质,复发概率高。首选手术治疗,肿瘤完全切除是预防肿瘤复发的最重要因素。对于非典型或恶性脑膜瘤,建议在初次手术后立即进行放疗。

Objective To investigate the clinical, imaging and histopathological features of intracerebral parenchymal or subcortical meningioma without meningeal attachment. Methods The clinical, imaging, and histopathological characteristics of 4 patients with subcortical meningioma without meningeal attachment who underwent surgical treatment at Hainan Provincial People’s Hospital from December 2019 to December 2022 were analyzed retrospectively. The principles of surgical management, surgical efficacy, and long-term follow-up results were summarized in conjunction with literature. Results The most common site for all patients was the frontal and parietal lobes, with 3 cases having cystic and solid lesions. Epilepsy was a common symptom before and after surgery. Three dimensional magnetic resonance imaging(MRI) showed that all tumors were located in the brain, and preoperative MRI, as well as intraoperative and postoperative pathology, confirm the absence of dural attachment. 4 patients underwent total resection, two were WHO grade Ⅰ, two were WHO grade Ⅱ, one had postoperative recurrence of atypical meningioma, one had no postoperative radiotherapy, and three received postoperative radiotherapy. After an average follow-up of 1.5 years, 3 cases survived. Conclusions Intracortical or subcortical meningiomas without meningeal attachment are easily misdiagnosed before surgery. Peritumoral edema in some subcortical or subcortical meningiomas occurs in areas where the lesion adheres to surrounding brain tissue, not surrounding the entire tumor surface. MRI spectroscopy and other features may be helpful in distinguishing. WHO grade Ⅱ atypical meningiomas have a high rate of proliferation, invasion of brain parenchyma, and a high probability of recurrence. Surgical treatment is the first choice, and complete tumor resection is the most important factor in preventing tumor recurrence. For atypical or malignant meningiomas, radiotherapy is recommended immediately after initial operation.

脑实质;脑皮质;硬脑膜附着;脑膜瘤;显微手术
朱蔚林,刘朝晖,谢永帆,赵建农
570311 海口,海南省人民医院神经外科
《临床神经外科杂志》
2024-(21)3
313-317
由万方数据知识聚合服务平台收录
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