Artikel
Clinical presentation and postoperative health related quality of life of patients with frequent types of skull base meningiomas of the posterior fossa
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Autoren
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B. Pintea
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Bonn
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J. Kandenwein
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Bonn
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F. Daher
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Bonn
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R.A. Kristof
- Klinik und Poliklinik für Neurochirurgie, Universitätsklinikum Bonn
| Veröffentlicht: | 4. Juni 2012 |
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Gliederung
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Objective: The aim of this study was to analyse the clinical presentation of frequent types of skull base meningiomas of the posterior fossa, and to identify factors of influence upon outcome, including health related quality of life (HRQoL), in patients who underwent surgical treatment.
Methods: We retrospectively review the clinical data of 78 consecutive patients with meningiomas of the posterior surface of the pyramid (PPM, n = 32) and petroclival meningiomas (PCM, n = 46) managed surgically at our institution from 1991 to 2007. The SF-36 questionnaire was used to assess the HRQoL of the patients. Multi- and univariate analysis of the data were performed to compare presentation and outcome of patients.
Results: The rate of dizziness was significantly higher in PPM (56% vs. 7%) and the rate of trigeminal nerve impairment was significantly higher in PCM (50% vs. 3%). Complete tumor resections were significantly more often achieved (90% vs. 39%), and surgery lasted significant shorter (median: 247 min vs. 500 min) with less blood loss (median: 525 ml vs. 1000 ml) in PPM as compared to PCM. The overall complication rates (72% vs. 31%) as well the rate of not reversible complications (79% vs. 30%) were significant higher in PCM than in PPM. The most frequent complications were in PCM eye movement (46% vs. 6%), facial nerve (28% vs. 3%) and swallowing impairments (21% vs. 3%), and in PPM wound healing complications (13% vs. 9%). The perioperative mortality was 11% in PCM and 0% in PPM patients. 69% of the patients (65% of PCM and 75% of PPM) completed the SF-36 questionnaire. At a median follow-up of 59 months, the SF-36 analysis showed no difference between the patient groups. The uni- and multivariate analysis showed for both groups the early postoperative Karnofsky Performance Index (KPI) to significantly correlate with HRQoL. For swallowing impairments in PCM there was a trend to inversely correlate with HRQoL.
Conclusions: Surgical treatment of PCM is associated with higher morbidity and mortality, as compared to PPM. However, HRQoL seems to adjust in the both groups after a time, and correlates with the early postoperative KPI. Persistent swallowing impairments may adversely influence the HRQoL in PCM.
