Background: Parasellar meningiomas, which may invade the cavernous sinus, pose a significant challenge to neurosurgeons due to the high risk of postoperative neurological deficits associated with aggressive resection of the intracavernous part of the tumour. Therefore, subtotal tumour removal followed by observation or radiotherapy for the residual meningioma in the cavernous sinus is recommended. This retrospective study aimed to identify prognostic factors influencing recurrence and progression-free survival (PFS) in parasellar meningiomas invading the cavernous sinus after incomplete surgical treatment. Methods: This study included adult patients diagnosed with benign parasellar meningioma (WHO Grade I) invading the cavernous sinus, treated at our institution between 2006 and 2020, and with a postsurgical follow-up of at least 3 years. Surgical treatment involved near-total resection (NTR) with an intracavernous residual tumour or subtotal resection (STR) with additional extracavernous tumour left in place. Kaplan–Meier analysis estimated PFS rates, and Cox regression tested survival time differences between groups. Results: Among the 32 patients, the estimated median PFS was 11 years. Radiotherapy improved 5-year PFS only in patients with STR (p= 0.003). The univariate analysis identified preoperative tumour size, low preoperative Karnofsky Performance Score (KPS), and marked brain oedema as significant factors affecting meningioma progression after surgery. The multivariate analysis confirmed tumour size as an independent factor for progression (p= 0.012). Conclusions: For patients with parasellar meningioma invading the cavernous sinus, extracavernous tumour removal followed by close radiological surveillance of the residual intracavernous meningioma is a safe and appropriate strategy. When an extracavernous tumour component is left, adjuvant stereotactic radiotherapy or radiosurgery is recommended to control tumour growth.
背景：鞍旁脑膜瘤可能侵犯海绵窦，由于积极切除肿瘤海绵窦内部分术后神经功能缺损风险较高，这对神经外科医生构成重大挑战。因此，建议对海绵窦内残留脑膜瘤进行肿瘤次全切除后观察或放疗。本回顾性研究旨在确定影响不完全手术治疗后侵犯海绵窦的鞍旁脑膜瘤复发和无进展生存期（PFS）的预后因素。方法：本研究纳入2006年至2020年间在我院接受治疗、术后随访至少3年、诊断为侵犯海绵窦的良性鞍旁脑膜瘤（WHO I级）的成年患者。手术治疗包括近全切除（NTR）伴海绵窦内残留肿瘤，或次全切除（STR）伴额外海绵窦外肿瘤残留。采用Kaplan-Meier分析估算PFS率，Cox回归检验组间生存时间差异。结果：在32例患者中，估计中位PFS为11年。放疗仅提高了STR患者的5年PFS（p=0.003）。单变量分析确定术前肿瘤大小、较低的术前卡氏功能状态评分（KPS）和明显脑水肿是影响术后脑膜瘤进展的重要因素。多变量分析证实肿瘤大小是进展的独立因素（p=0.012）。结论：对于侵犯海绵窦的鞍旁脑膜瘤患者，切除海绵窦外肿瘤后对残留海绵窦内脑膜瘤进行密切影像学监测是一种安全且恰当的策略。当有海绵窦外肿瘤成分残留时，建议辅助立体定向放疗或放射外科治疗以控制肿瘤生长。
Risk of Tumor Progression after Microsurgery for Parasellar Meningioma Invading the Cavernous Sinus
肿瘤(癌症)患者之家