颅内恶性脑膜瘤29例报告及文献复习  

Intracranial malignant meningiomas (A report of 29 cases and review of the literatures)

作　　者：刘巍[1] 张懋植[1] 王集生[1] 罗麟[2] 朱晓东[3] 赵继宗[1] 

机构地区：[1]首都医科大学附属北京天坛医院神经外科,100050 [2]北京市神经外科研究所病理室 [3]首都医科大学附属北京天坛医院病案科

出　　处：《北京医学》2008年第4期193-197,共5页Beijing Medical Journal

基　　金：国家高技术研究发展计划(863计划)项目(2002BA711A08)

摘　　要：目的探讨恶性脑膜瘤的临床及病理学特点。方法结合文献,对29例恶性脑膜瘤患者的临床资料进行回顾性分析。结果29例包括脊索样型、非典型、乳头型、间变型脑膜瘤,占同期脑膜瘤的0.65%。本组均行显微外科手术,共32例次;SimpsonⅠ～Ⅱ级19例,Ⅲ级12例,Ⅳ级1例,随访25例(2～98个月,平均30.9个月),复发率为52%(其中SimpsonⅠ～Ⅱ级占46.2%),死亡率为36%;手术全切(SimpsonⅠ～Ⅱ级)+术后放疗者的复发率为27.3%,单纯手术全切复发率高达50%。结论同良性脑膜瘤相比,此病术前诊断有一定难度且预后差。就目前资料而言,手术全切尚不足以避免肿瘤复发,但可尽量减少肿瘤细胞数量,需再结合放疗以延缓肿瘤复发。Objective To discuss clinicopathologic features of intranial malignant meningiomas based on WHO 2000 criteria. Methods The clinical features of 29 cases with intracranial malignant meningiomas confirmed by operation and pathologic examination were analyzed retrospectively with the literature reviews. Results In this study, pathological subtypes of 29 cases of malignant meningiomas included chordoid, atypical, papillary and anaplastic meningiomas, which constituted 0.65% of all meningiomas at that time. Microsurgical resection was performed with Simpson Grade I to II in 19 cases and Grades III to Ⅳ in the other 13 cases. 9 of 25（36%） patients died and 13 of 25（52%） patients experienced recurrence during a median follow-up time of 30.9 months（46.2% of them belonging to Simpson I-II ）. There were recurrences in 11 cases, 3 （27.3%） of which had undergone gross total resection and adjunctive radiation therapy, whereas, 2 of 4 cases （50%） of recurrence had only gross total resection. Conclusions Compared with benign meningiomas, it is difficult to have a definite diagnosis for malignant subtypes because of atypical clinical and radiologic manifestation. At present, radical surgical excision and adjunctive radiation therapy after both total and subtotal resection are still considered as the choice of treatment and a cooperative group study would be required to assess effectiveness.

关 键 词：非典型脑膜瘤 间变型脑膜瘤 病理学 手术全切 

分 类 号：R739.4[医药卫生—肿瘤]