論文

査読有り
2013年12月

Effect of dural detachment on long-term tumor control for meningiomas treated using Simpson Grade IV resection

JOURNAL OF NEUROSURGERY
  • Yuta Fukushima
  • ,
  • Soichi Oya
  • ,
  • Hirofumi Nakatomi
  • ,
  • Junji Shibahara
  • ,
  • Shunya Hanakita
  • ,
  • Shota Tanaka
  • ,
  • Masahiro Shin
  • ,
  • Kensuke Kawai
  • ,
  • Masashi Fukayama
  • ,
  • Nobuhito Saito

119
6
開始ページ
1373
終了ページ
1379
記述言語
英語
掲載種別
研究論文(学術雑誌)
DOI
10.3171/2013.8.JNS13832
出版者・発行元
AMER ASSOC NEUROLOGICAL SURGEONS

Object. Meningiomas treated by subtotal or partial resection are associated with significantly shorter recurrence-free survival than those treated by gross-total resection. The Simpson grading system classifies incomplete resections into a single category, namely Simpson Grade IV, with wide variations in the volume and location of residual tumors, making it complicated to evaluate the achievement of surgical goals and predict the prognosis of these tumors. Authors of the present study investigated the factors related to necessity of retreatment and tried to identify any surgical nuances achievable with the aid of modern neurosurgical techniques for meningiomas treated using Simpson Grade IV resection.
Methods. This retrospective analysis included patients with WHO Grade I meningiomas treated using Simpson Grade IV resection as the initial therapy at the University of Tokyo Hospital between January 1995 and April 2010. Retreatment was defined as reresection or stereotactic radiosurgery due to postoperative tumor growth.
Results. A total of 38 patients were included in this study. Regrowth of residual tumor was observed in 22 patients with a mean follow-up period of 6.1 years. Retreatment was performed for 20 of these 22 tumors with regrowth. Risk factors related to significantly shorter retreatment-free survival were age younger than 50 years (p = 0.006), postresection tumor volume of 4 cm(3) or more (p = 0.016), no dural detachment (p = 0.001), and skull base location (p = 0.016). Multivariate analysis revealed that no dural detachment (hazard ratio [BR] 6.42,95% CI 1.41-45.0; p = 0.02) and skull base location (HR 11.6, 95% CI 2.18-218; p = 0.002) were independent risk factors for the necessity of early retreatment, whereas postresection tumor volume of 4 cm(3) or more was not a statistically significant risk factor.
Conclusions. Compared with Simpson Grade I, II, and III resections, Simpson Grade IV resection includes highly heterogeneous tumors in terms of resection rate and location of the residual mass. Despite the difficulty in analyzing such diverse data, these results draw attention to the favorable effect of dural detachment (instead of maximizing the resection rate) on long-term tumor control. Surgical strategy with an emphasis on detaching the tumor from the affected dura might be another important option in resection of high-risk meningiomas not amenable to gross-total resection.

リンク情報
DOI
https://doi.org/10.3171/2013.8.JNS13832
PubMed
https://www.ncbi.nlm.nih.gov/pubmed/24053497
Web of Science
https://gateway.webofknowledge.com/gateway/Gateway.cgi?GWVersion=2&SrcAuth=JSTA_CEL&SrcApp=J_Gate_JST&DestLinkType=FullRecord&KeyUT=WOS:000327367200004&DestApp=WOS_CPL
ID情報
  • DOI : 10.3171/2013.8.JNS13832
  • ISSN : 0022-3085
  • eISSN : 1933-0693
  • PubMed ID : 24053497
  • Web of Science ID : WOS:000327367200004

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