恶性脑膜瘤的临床特点及诊疗体会

摘要

目的：总结恶性脑膜瘤的临床特点及诊疗体会。方法回顾性分析解放军总医院收治的27例经病理证实为恶性脑膜瘤（ WHOⅢ级）患者的临床表现、诊治经过、术后辅助治疗及预后等资料，窦镰旁恶性脑膜瘤7例，大脑凸面恶性脑膜瘤8例，蝶骨嵴恶性脑膜瘤5例，岩斜区等其他部位恶性脑膜瘤7例，其中肿瘤直径＞5 cm 19例。主要影像学特点为磁共振增强扫描呈明显不规则强化，周围水肿带明显。结果27例恶性脑膜瘤病例中，间变型恶性脑膜瘤18例，横纹肌样恶性脑膜瘤7例，乳头型恶性脑膜瘤2例。患者均行显微手术治疗，无死亡病例。按照Simpson标准，SimpsonⅠ级切除者11例，SimpsonⅡ级切除者6例，SimpsonⅢ级切除者6例，SimpsonⅣ级切除者4例。随访平均37．2个月，Ⅰ～Ⅱ级切除者7例（41．2％）出现复发，Ⅲ～Ⅳ级切除者患者均复发（100％）。其中，术后放疗者13例，未行放疗者14例，复发率分别为61．5％及78．6％。结论恶性脑膜瘤易复发，治疗首选显微外科全切除肿瘤，并处理硬膜及受累颅骨，术后应辅以放疗。%Objective To summarize the clinical characteristics of the malignant meningioma and experiences on diagnosis and treatment .Methods To retrospectively analyze clinical characteristics ,treatment and the result in patients suffered from malignant meningioma that were confirmed by pathology in the people's liberation army general hospital .There were 7 parasagittal and parafalx malignant meningiomas , 8 convexity malignant meningiomas , 5 sphenoid ridge malignant meningiomas and 7 petroclival or other malignant meningiomas .Diameter of 19 cases were greater than 5cm.Main imaging features were the obvious irregular enhancement and surrounding edema in the enhanced MRI scanning .Results There were 18 anaplastic malignant meningiomas , 7 rhabdoid malignant meningiomas and 2 papillary malignant meningiomas .All 27 patients were performed microsurgery treatment under microscope and no deaths .According to the standard of Simpson , the excision of Simpson gradeⅠwas of 11 cases ,gradeⅡof 6 cases , gradeⅢof 6 cases , and the grade four ofⅣcases.Monitoring time was 37.2 months.7 cases (41.2%) in the tumor were recurrent under the excision of Simpson grade one to two ,all (100%) patients were recurrent under the excision of Simpson grade three to four .13 cases of them then were followed by radiation treatment ,recurrent rate was 61.5%,while it was 78.6% of 14 cases who were not followed by any treatment .Conclusion Malignant meningioma was easily recurrent ,and total removal of it was the first choice .We should treat the affected epidural and skull .It should also be followed by radiotherapy .