Microsurgical Treatment And Prognosis For Different Types Of Sphenoid Ridge Meningiomas

Objective: To summarize the clinical features,microsurgical techniques and prognosis of different types of sphenoid ridge meningioma,and to explore its biological behaviors and treatment strategies.Methods: The clinical data of patients with sphenoid ridge meningioma who underwent microsurgery in our department from August 2009 to February 2017 were retrospectively analyzed.The tumor size was divided into small,medium,and large;the peritumoral edema was divided into non-severe edema and severe edema;the degree of tumor excision was divided into total resection,subtotal resection,and partial resection.The related factors of peritumoral edema were analyzed by chi-square test and t-test,and the effects of tumor resection,pathological type and grade on postoperative recurrence were analyzed,and the causes and treatment strategies were further explored.Results: There were 72 patients in this group.The preoperative symptoms were mostly headache(59.7%)and visual acuity(50.0%).The average duration was 19 months.There were 35 cases of anterior coticular projection,11 cases of sphenoid winglet,and 26 cases of sphenoid winglet.There were 51 WHOI patients,19 WHO II patients,and 2 patients WHO III patients.The percentages of patients above WHO II were 48.0%(12/25)in males and 19.1%(9/47)in females,and 22.9% in the anterior clinoid type(8/35).),27.3%(3/11)of sphenoid winglet,38.5%(10/26)of sphenoid wing,small 0(0/10),medium 28.3%(13/46),large 50.0%(8)/16);tumors with severe peritumoral edema in 30 cases,non-severe peritumoral edema in 42 cases.The incidence of severe peritumoral edema was 33.3% in WHO grade I and 63.2% in WHO II grade,with statistically significant differences(P<0.05),small 0(0/10),medium 50.0%(23/46),and large 43.8%(7/16),severe peritumoral edema in small cases was significantly lower than that in medium and large size,respectively(P<0.05);31.4%(11/35)in the anterior clinoids,18.2%(2/11)in sphenoid winglets,and butterfly There were 65.4%(17/26)of great airfoils,and severe periapical edema of sphenoidal wing type was significantly higher than that of sphenoid winglet and anterior coticular type,respectively(P<0.05).Subtotal tumor resection in 15 cases,total resection in 57 cases;total resection,subtotal resection of tumors with a mean maximum diameter of 4.6cm,5.6cm,statistically significant difference(P <0.05);anterior clinoid,non-frontal clinoid The total resection rate of meningiomas was 68.6%(24/35)and 89.2%(33/37),respectively,with statistically significant differences(P<0.05).The tumors that failed to be completely cut were more likely to adhere to the internal carotid artery and cavernous sinus..60 cases were followed up for an average of 3.6 years,including 15 cases of recurrence;tumor recurrence rate,total resection was 16.7%(8/48),subtotal resection was 58.3%(7/12),subtotal resection was significantly higher than the recurrence rate Resection(P < 0.05).The recurrence rate of WHOI and total resection was 11.4%(4/35).The recurrence rate of WHOI and subtotal resection was 50.0%(3/6).The recurrence rate of WHOII grade and Simpson grade II was 37.5%(3/8).In 5 cases without recurrence,the Ki-67 was 2% to 5%.WHO class II and subtotal resection soon recurred.Two cases of WHO grade III(all from the progression of low-grade meningiomas),died after recurrence within 1 year after surgery.Conclusions: 1.The pathological grade of sphenoid ridge meningioma is closely related to gender,location and size.Male,large,and sphenoid winged meningiomas have relatively higher pathological grades.2.Peritumoral edema of sphenoid ridge meningioma is closely related to its size,location and pathological grade.The size and location of the tumor will affect cerebral venous return to a certain extent.The obstruction of cerebral venous return and the different pathological types are important causes of edema.3.The pathological grade of sphenoid ridge meningioma is closely related to gender,location,and size,which can be used as the basis for predicting the pathological grade of meningioma early.4.The recurrence rate of total removal of sphenoid ridge meningioma is low,and total resection should be sought under the premise of safety.Subtotal resection of tumors was associated with pathological types and Ki-67 values.