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首页> 外文期刊>Journal of neurosurgery. >Primary extradural meningiomas: a report on nine cases and review of the literature from the era of computerized tomography scanning.
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Primary extradural meningiomas: a report on nine cases and review of the literature from the era of computerized tomography scanning.

机译：硬膜外原发性脑膜瘤：9例病例报告和计算机断层扫描时代的文献回顾。

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OBJECT: Primary meningiomas arising outside the intracranial compartment (primary extradural meningiomas [PEMs]) are rare tumors. To develop a better understanding of these tumors and to establish a comprehensive classification scheme for them, the authors analyzed a series of patients treated at the M. D. Anderson Cancer Center (MDACC) and reviewed all cases reported in the English-language literature since the inception of the use of computerized tomography (CT) scanning. METHODS: Clinical records, results of radiographic studies, and histological slides were reviewed for all cases of PEM at MDACC. Demographic features, symptoms, tumor location, histological grade, and patient outcome were assessed in all cases. A comprehensive literature search identified 168 PEMs in 142 patients reported during the CT era. These reports were also analyzed for common features. Tumors for both data sets were classified as purely extracalvarial (Type I), purely calvarial (Type II), and calvarial with extracalvarial extension (Type III). Type II and Type III tumors were further categorized as convexity (C) or skull base (B) lesions. The incidence of PEMs at MDACC was 1.6%, which was consistent with the rate reported in the literature. In both data sets, the male/female ratio was nearly 1:1. The most common presenting symptom was a gradually expanding mass. The age of patients at diagnosis of PEM was bimodal, peaking during the second decade and during the fifth to seventh decades. In all MDACC cases and in 90% of those reported in the literature the PEMs were located in the head and neck. The majority of tumors originated in the skull (70%). In the MDACC series and in the literature review, the majority (67% and 89%, respectively) of tumors were histologically benign. Although fewer PEMs were malignant or atypical (33% at MDACC and 11% in the literature), their incidence was higher than that observed for primary intracranial meningiomas. Distant metastasis was not a common feature reported for patients with PEMs (6% in the literature). Outcome data were available in 96 of the cases culled from the CT-era literature. The combination of the MDACC data and the data obtained from the literature demonstrated that patients with benign Type IIB or Type IIIB lesions were more likely to experience recurrence than patients with benign Type IIC or Type IIIC tumors (26% compared with 0%, p < 0.05). The more aggressive atypical and malignant tumors were associated with a statistically significant higher death rate (29%) relative to benign tumors (4.8% death rate, p < 0.004). CONCLUSIONS: Defining a tumor as a PEM is dependent on the tumor's relation to the dura mater and the extent and direction of its growth. Classification of PEMs as calvarial or extracalvarial and as convexity or skull base lesions correlates well with clinical outcome.
机译：目的：颅内腔外发生的原发性脑膜瘤（原发性硬膜外脑膜瘤[PEMs]）是罕见的肿瘤。为了更好地了解这些肿瘤并为它们建立全面的分类方案，作者分析了MD安德森癌症中心（MDACC）所治疗的一系列患者，并回顾了自从该文献成立以来英语文献中报道的所有病例。使用计算机断层扫描（CT）扫描。方法：对MDACC所有PEM病例的临床记录，影像学检查结果和组织切片进行回顾。所有病例均评估了人口统计学特征，症状，肿瘤位置，组织学分级和患者预后。全面的文献检索确定了CT时代报告的142例患者中的168个PEM。还分析了这些报告的常见功能。两种数据集的肿瘤​​均分为纯颅外（I型），纯颅盖骨（II型）和具有颅外延伸的颅盖型（III型）。 II型和III型肿瘤进一步分为凸性（C）或颅底（B）病变。 MDACC中PEM的发生率为1.6％，与文献报道的发生率一致。在这两个数据集中，男女比例接近1：1。最常见的症状是肿块逐渐扩大。诊断为PEM的患者年龄是双峰的，在第二个十年和第五个到第七个十年达到高峰。在所有MDACC病例中，在文献报道的90％中，PEM位于头部和颈部。大多数肿瘤起源于头骨（70％）。在MDACC系列和文献综述中，大多数肿瘤（分别为67％和89％）在组织学上是良性的。尽管恶性或非典型PEM较少（MDACC为33％，文献中为11％），但其发生率高于原发性颅内脑膜瘤。远处转移并非PEM患者的普遍报道（文献报道为6％）。从CT时代文献中筛选出的96例病例中有结果数据。 MDACC数据和从文献中获得的数据的结合表明，良性IIB或IIIB型病变的患者比良性IIC或IIIC型肿瘤的患者更有可能复发（26％比0％，p < 0.05）。与良性肿瘤（4.8％的死亡率，p <0.004）相比，更具侵略性的非典型和恶性肿瘤的死亡率有统计学意义的更高（29％）。结论：将肿瘤定义为PEM取决于肿瘤与硬脑膜的关系以及其生长的程度和方向。 PEM的分类为颅底或颅底病变，以及凸面或颅底病变与临床结局密切相关。

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