Clinical Features And Surgical Treatment Of Invasive Meningiomas

Objective:To explore the clinical and pathological features, surgical treatment of invasive meningiomas.Methods:61 patients with invasive meningiomas which were hospitalization and treatment in Department of Neurosurgery,Qilu Hospital of Shandong University between January 2009 and December 2009 were analyzed retrospectively.The clinical manifestations, radiological features, diagnosis and surgical treatment, pathological features, postoperative complications and management are discussed. All the patients were diagnosed preoperatively by MRI (magnetic resonance imaging) and (or) CT (computed tomography), tree patients accepted MRA (magnetic resonance angiography) and one was inspected by DSA (digital subtraction angiography). Simpson grade were used to evaluate the tumor resection.Results:Patients with invasive meningiomas is about 72.6%of all the intracranial meningiomas during the same period. The series included 14 males and 47 females.The age of the patients ranges from 19 to 75 years, the average is 50.7; The average duration from initial symptoms to diagnosis was about 38 months (range, 1days-22years). Classification according to the location of the tumor base, convexity meningiomas in 15, parasagittal sinus meningiomas in 11, parafalcine meningiomas in 3, multiple meningiomas in 3, meningiomas of the skull base in 29(13 cases of tentorial meningiomas,3 cases of sphenoid ridge meningiomas,3 cases of tuberculum sellae meningiomas,3 cases of petrous bone meningiomas,5 cases of anterior cranial fossa meningiomas,2 cases of middle cranial fossa meningiomas). The common clinical manifestations of invasive meningiomas were headache or dizziness in 40 patients, limb dysfunction in 14, decreased visual acuity in 7,epilepsy in 5,gait ataxia in 5, hearing loss in 2, without symptoms and signs in 2, the others in 5.All patients with invasive meningiomas in this group are received surgical treatment. Total resection (Simpson grade I and II) was achieved in 50 cases, Subtotal resection was in 11 cases. Pathological examination after operation revealed 55 benign,5 atypical and 1 malignant. Postoperatively, hemiparalysis occurred and aggravated in 5, epilepsy in 2 and no death; Postoperative complications disappeared or improved after therapy. The follow-up was available in 55 patients. The mean duration of follow-up was 18 months. There was no recurred case. Karnofsky Performance Scale was used to evaluate the patients:100 scores in 31 patients,90 scores in 12,70 scores in 10,60 scores in 1,50 scores in 1.Conclusions:â‘ Invasive meningiomas occur mainly in perimenopausal women. Clinical symptoms are associated with location of the tumor.â‘¡Preoperative imaging is an effective means to diagnose invasive meningiomas. To observe the abnormal changes of bone, especially to the minor changes, CT is superior to MRI. But MRI is more sensitive than CT in detecting the base of tumor and morphological changes of peritumoral zone.â‘¢urgery is the primary choice for invasive meningiomas. Tumoral location,type and extent of tissue invaded by tumor are the determinative factors of total resection.