Microsurgery For Skull Base Meningioma And Analysis Of Factors Influencing Complications

Objection To study some related factors influencing degree of tumor resection,surgical complications of skull base meningiomas.Methods We collected the medical data of the skull base meningiomas that were operated in the 14 th neurosurgical department in Tian Jin Huan Hu Hospital,during a 4-year period from January 1,2011 to December 31,2014.The outcomes in 121 patients were ascertained through follow visits,and telephone interviews.We analyzed about 22 factors, including gender, age, course of disease, complaints, past medical history,tumor location, tumor size, tumor invasiveness, neurovascular wrap, peritumoral edema, tumor border, calcification of tumor, tumor shape, tumor enhancement degree, surgical approaches,pathological subtypes,postoperative complications,etc.The data were analyzed by univariate and multivariate analyses.The Chi-Square test,Binary logistic regression analysis were used to analyze the prognostic factors.Meanwhile,This paper concretely discusses the classification and related factors of postoperative complications, describes the postoperative follow-up survey.Results 1.there were 121 patients, The mean age was 54.49 years with a predominance of women in a ratio of 2.18:1.Duration of symptoms ranged from 1 day to 10 years.3 patients discovered meningioma accidentally, and 39 patients with memory decline, dizziness, fatigue and other symptoms,however physical examination without positive signs. 67 patients with preoperative focal neurological dysfunction;14 patients with symptoms of increased intracranial pressure. 2.The tumors location were as follow:tuberculum sellae,27 cases;olfactory groove,9 cases;middle and external third sphenoid wing,29 cases;cavernous sinus,9 cases; CPA,14 cases;lateral petrous bone,17 cases;middle fossa,9 cases;clivus,5 cases;foramen,2 cases. 3.In all patients, total resection in 106 cases, subtotal resection in 13 cases,and partial resection in 2 cases, total resection rate was 87.60%. No preoperative died in any patient, 29 cases(23.97%) of patients with postoperative complications, including 21 cases(17.36%) of patients with complications of nervous system.Neurologicalcomplications including 15 cases(12.40%), cranial nerve function deterioration; 4 cases(3.31%), cerebrospinal fluid leakage;2 cases of epilepsy(1.65%); 1 case(0.83%), intracranial infection;1 case(0.83%), cerebral infarction.During follow-up, 10 cases of neurologic recovery, 5 cases had nerve dysfunction, including 3 cases of facial paralysis, 1 case of abducens nerve paralysis, 1 case with visual acuity decrease. 4.Tumor location and vessels wrap around are the main factors to influence the degree of tumor resection.Skull base meningioma full cut rates with the edge of the area, central area, paramidline area gradually reduce.Meningioma in the central region of the skull base low degree of tumor resection ratio were 5.300 to the edge region of the skull base. 5.Tumor invasiveness and location are the main factors of complications.Invasive meningioma preoperative focal neurological deficit complications ratio was 6.464 to non-invasive meningioma.Paramidline area and central area meningiomas were higher than risk of postoperative neurologic complications appear edge area, respectively 6.375 times, 2.056 times of that for the latter.Conclusion 1.Tumor location and vessels wrap around are the main factors to influence the degree of tumor resection.Skull base meningioma total resection rates with the edge of the area, central area, paramidline area gradually reduce. 2.Tumor invasiveness and location are the main factors of complications.Paramidline area and central area meningiomas were higher than risk of postoperative neurologic complications appear edge area. 3.The paramidline area anatomical structures are complex. Meningiomas are often associated with cranial nerve adhesion; subtotal resection and postoperative complications are prone to occur. 4.After considering the preoperative state, imaging findings, patients can obtain satisfactory outcome after operation in the professional group.