Analysis Of Influence Factors Of Resection And Complications In Non Skull Base Deep-seated Meningiomas

Objective: To investigate the clinical characteristics in non skull base deep-seated meningioma patients. Analysing the factors that affect the surgical resection and postoperative complications to provide a reference for the future evaluation of the therapeutic effect of these meningiomas and to improve the prognosis of patients.Methods: To review of 67 cases of non skull base deep-seated meningioma patients in fourteen ward of Tianjin Huanhu Hospital from January 2011 to December 2014 treated by the same operator. Non skull base deep-seated meningiomas were limited to para sinus(superior parasagittal meningiomas were limited the base of the tumor near the falx cerebri and was buried in the cortex, inferior sagittal sinus, straight sinus), falx, intraventricular and tentorium of cerebellum. The general data, clinical manifestations, imaging features, surgical data, pathological type, postoperative complications were recorded. The general clinical characteristics of non skull base deep-seated meningioma patients were summarized, 67 cases of patients with gender, age, course of disease, medical history, complaints, positive signs, tumor location, size, shape, degree of enhancement, calcification, texture, blood supply, vessels and nerves wrap around, invasiveness, boundary, peritumoral edema, pathological subtypes of the 18 factors, Univariate analysis(chi-square test or Fisher test)was performed to analyze various factors that influence degree of tumor resection,surgical complications, screening out the factors related to tumor resection and postoperative complications, and factors of statistically significant as independent variable for binary Logistic stepwise regression analysis.Results: 1(1). A total of 67 cases, 26 males, 41 female, the ratio between male and female was 1: 1.57; the average age was 50.9 years(23- 73 years); the average duration was 15.8 months(2 days- 12 years), admission of 67 patients with symptoms and signs including: 17 cases with headache, dizziness, fatigue, poor mental and subjective symptoms, but without obvious positive signs, 28 cases with focal neurological symptoms, 32 cases with intracranial hypertension, 4 cases occasionally found.(2). According to tumor of dural attachment site the non skull base deep-seated meningiomas were divided into para sinus were found in 24 cases(35.8%), of which 22 cases in the superior parasagittal, 1 case in inferior parasagittal, 1 case in straight sinus; 21 cases(31.3%) of falx; 7 cases(10.4%) of ventricle, of which 6 cases in the lateral ventricle, 1 case in third ventricle; 15 cases(22.4%) of tentorial of cerebellum, which 7 cases of supratentorial, 5 cases of infratentorial, 3 cases were found in both.(3). Of all patients, 56 cases(83.6%) were complete removal of the tumor(Simpson grade I and II), subtotal(Simpson III) in 9 cases(13.4%), and partial resection(Simpson grade IV) in 2 cases(3.0%), non of was Simpson V grade resection. There were 12 cases(17.9%) postoperative neurological complications, including 6 cases of cerebral neurological deficits, 2 cases of epilepsy, 1 cases of hemorrhage, 3 cases of subcutaneous effusion, no perioperative deaths. 2. The result of single factor analysis(1)The differences of factors, which influenced resection extent of meningioma, tumor invasiveness, vessels and nerves wrap around, tumor margin, peritumoral edema and degree of tumor enhancement were statistical significance(P<0.05)。(2)The differences of factors, which influenced postoperative complications of meningioma, duration of disease, focal neurological dysfunction, vessels and nerves wrap around, tumor invasiveness, degree of tumor enhancement and peritumoral edema were statistical significance(P<0.05). 3. Results of Binary Logistic stepwise regression analysis(1)Tumor invasiveness, vessels and nerves wrap around, tumor margin, peritumoral edema are four independent risk factors of tumor residual, and tumor invasiveness is the main risk factor.(2)Focal neurological dysfunction, vessels and nerves wrap around, tumor invasiveness, peritumoral edema are four independent risk factors of surgical complications, and vessels and nerves wrap around is the main risk factor of surgical complications.Conclusion: 1.Non skull base deep-seated meningioma with invasiveness, seriously peritumoral edema, unclear boundary of tumor and vessels and nerves wrap around can effect the extent of the surgical resection of the tumor. 2.Of all the factors effected the extent of resection, tumor with invasiveness is the main factor, the risk of not complete resection of tumor with invasiveness is 532.1 times of without invasiveness. 3.Patients with preoperative focal neurological dysfunction, peritumoral vascular and nerve wrapping and tumor with invasiveness and serious peritumoral edema can increase the risk of postoperative complications. 4.Of all the factors effected postoperative complications, tumor with vessels and nerves wrap around is the main factor, the risk of increasing postoperative complications of tumor with vessels and nerves wrap around is 4.121 times of not. 5.Before treating non skull base deep-seated meningioma, assessing of preoperative status of patients and reading image information carefully and treating blood vessels and nerves around the tumor careful intraoperative can effectively reduce tumor residual. Making a good balance between tumor residues and retention of neural function of patients can effectively reduce the postoperative complications, improve patient prognosis.