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[Microsurgery for parasellar menningiomas and impact factors of recurrence]
Dun Yuan1, Dingyang Liu, Xianrui Yuan
1Department of Neurosurgery, Xiangya Hospital, Central South University, Changsha 410008, China.
Objective:
To study the effect of microsurgery for parasellar menningiomas and to analyze the impact factors of recurrence.
Methods:
Clinical and follow-up data in a consecutive series of 134 patients with parasellar meningiomas were retrospectively analyzed.
Results:
A total of 109 patients (81.3%) had radical removal (Simpson grade I and II), and 116 patients were followed up for an average period of 81.6 months. The mean quality of life score (KPS) was 91.9, 90 patients regained full daily activity and 16 patients were able to take care of themselves. Oculomotor paralysis occurred in 7 patients, epilepsy in 8, and another 9 patients suffered hemispheral paralysis. Tumor recurred after the radical removal in 12 out of the 96 followup patients (12.5%). Tumor progressed after subtotal removal in 12 out of the 20 follow-up patients (60%). Tumor with cavernous sinus (CS) invasion had significantly higher risk of recurrence campared with non-CS invasion (P=0.043). The recurrence rate increased with the pathological grade (P<0.01).
Conclusion:
Patients with parasellar meningiomas undergoing microsurgical resection may have a good long-term function outcome. For most patients, total removal by microsurgery is the first choice. Careful follow-up is needed if tumor invaded the CS and radiosurgery is proposed for WHO grade 1 and 2.
Insights
Microsurgery offers good functional outcomes for parasellar meningiomas. Total removal is preferred, but cavernous sinus invasion and higher pathological grade increase recurrence risk, necessitating careful follow-up.
Area of Science:
- Neurosurgery
- Oncology
Context:
- Parasellar meningiomas are tumors located near critical neurovascular structures.
- Microsurgery is a primary treatment modality for these tumors.
Purpose:
- To evaluate the effectiveness of microsurgery for parasellar meningiomas.
- To identify factors influencing tumor recurrence after surgical resection.
Summary:
- Retrospective analysis of 134 patients with parasellar meningiomas treated with microsurgery.
- High rates of radical removal (81.3%) and good functional outcomes (KPS 91.9) were observed.
- Recurrence rates were 12.5% after radical removal and 60% after subtotal removal. Cavernous sinus invasion and higher pathological grade were significant risk factors for recurrence.
Impact:
- Microsurgical resection can lead to favorable long-term functional outcomes for patients with parasellar meningiomas.
- Total removal is recommended as the primary treatment strategy.
- Patients with cavernous sinus invasion or higher pathological grades require vigilant follow-up, with radiosurgery considered for WHO grade 1 and 2 tumors.
