Artikel
Post-operative outcome of anterior skull base meningiomas
Postoperativer Verlauf von Meningiomen der vorderen Schädelgrube
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Autoren
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A. Knüppel
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden, Dresden, Deutschland
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M. Kirsch
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden, Dresden, Deutschland
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G. Schackert
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden, Dresden, Deutschland
| Veröffentlicht: | 11. April 2007 |
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Gliederung
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Objective: The purpose of this retrospective study was to analyze the outcome and recurrence of anterior skull base meningiomas.
Methods: A total of 571 meningiomas were operated upon between Jan.1994 and Dec.2002. Of these, 151 were located within the anterior skull base, namely the frontal base, sphenoid wing, tuberculum sellae, cavernous sinus and olfactory groove. 141 patients were available for follow-up including regular outpatient visits and a questionnaire.
Results: The median age was 62.5 years, the male:female ration was 1:2.5. The patients most commonly presented with visual deficits (37%), headaches (25%), dizziness (16%), seizures (12%) or symptoms of organic psychosis (11%). Median tumor volume was 9,7cm3, mean volume was 26.1±35.6cm3. The most frequent histology subtypes were meningothelial (67%) and transitional (18%) meningiomas, whereas WHO°II meningiomas appeared only twice (1.4%). Intraoperative radicality was in 16% Simpson grade 1, 59% grade 2, 13% grade 3 and 15% grade 4, biopsies (grade 5) were not done. Operative radicality was associated with location, with medial sphenoid wing and cavernous sinus meningiomas being the most difficult to resect completely. Preoperative angiography was completed in 30 patients including 12 embolizations. Upon follow-up MR imaging, residual or recurrent tumour was diagnosed in 12.7% of the cases. Simpson grading correlated well, while angiomatous or fibrous histological subtype correlated with incidence of recurrence. GOS rating demonstrated that 5 patients (3.6%) died within 6 months post-op (grade 1), 1 pt. remained in grade 2, 80.7% recovered to grade 5. Resected tumours Simpson grade 1 and 2 were more likely to show a good outcome (GOS 5 in 97% and 82%, respectively). 64% of preoperatively full-time employed patients were able to return to their previous work place, 27% had to start a gradual re-integration programme, 9% were not able to return to work.
Conclusions: Anterior skull base meningiomas can be completely resected depending on their location and involvement of other structures. The most important predictor of post-operative outcome was Simpson grade, age and location. Repeated MR is required for reliable assessment of recurrent tumour growth.
