The Expression Of Survivin And Microsurgery Treatment And Factors Related To Postoperative Recurrence Of Sphenoid Wing Meningiomas

Objective:To explore IAPS (Inhibitor Apoptosis Protein Survivin) expression in the sphenoid wing meningiomas (SWMs) as well as the relationship between expression of IAPS and clinical prognosis of SWMs. Besides, providing a new theoretical reference to predict the development status and to evaluate clinical prognosis in SWMs.Materials and Methods:1. We collected clinical data and follow-up information of84patients with SWMs treated in Wuhan TongJi hospital between January2000to October2014, and stratified analysis according to the different characteristics of tumor. We analysed the prognostic factors related to recurrence and death during the follow-up period.2. We detected the expression of IAPS in tumor pathological specimens of84primary and17recurrent SWMs with SP immunohistochemical method, and statistically analysed the IAPS positive expression rate and expression intensity of SWMs with different characteristics, and analysed the relationship between expression of IAPS and clinical prognosis.Results:1. In our group, the positive expression rate of IAPS was53.6%of84samples. The positive expression rate and expression intensity of IAPS had significant difference among several factors.2. The patients with high intensity expression of IAPS (IDS6-12) had higher risk of recurrence and death than did in low intensity of IAPS (IDS0-4).Conclusion:1. IAPS had high expression in SWMs, and the higher expression corresponded to higher pathological level.2. IAPS had high expression in SWMs with skull invasion characteristics and recurrent or dead SWMs.3. IAPS play an important role in the occurrence, development and evolution of SWMs. and high expression state could be a reference indicator of adverse clinical outcomes. Objective:To summarize the microsurgical technique and analyze the factors influencing the recurrence of Sphenoid wing meningiomas(SWMs). And provide a new idea and an effective approach for the comprehensive treatment of SWMs.Methods:A retrospective analysis of121cases SWMs was performed upon the clinical data treatment and follow-up results collected from the neurosurgy department of the TongJi hospital between January2004and October2014. Summarize the microsurgical strategy for different clinical features of SWMs. A statistic analysis Was made on the related factors such as gender, age, tumor morphous, biobehaveoral, surgically resecting degree and the pathological type. The factors related to recurrence of SWMs were analyzed by Kaplan-Meier method, log-rank test and Cox multivariate regression analysis.Result:1. A result of121patients with SWMs, Total removal rate of is61.2%. Clinical symptoms were improved in most of postoperative patients.2cases died after operation.109patients were followed up after the operation,28cases recurred and recurrence rate was25.7%. The recurrence time ranges from8months to74months after microsurgical therapy, the mean recurrent time is39.1months.2. Univariate and multivariate analyses showed that gender, age, tumor size and location have no obvious relation with the recurrence, but different tumor biological behavior, surgical resection and the pathological grade were significantly correlated with the recurrence.Conclusions:1. Following the principles of devascularity, all dissections within the arachnoidal planes and orthotopic resection as far as possible, we could obtain satisfactory surgical results.2. Adopt different microsurgical technique for the tumor of different biological behavior features, such as, the tumor invading the cavernous sinus or the skull bone, enwinding the internal carotid artery and its branch, we could acquire maximize resection on the basic of minimizing surrounding brain tissue damage. Improve the surgical resection rate is the most important means of avoid the tumor recurrence. 3. The tumor invading the cavernous sinus and the skull bone, enwinding the internal carotid artery(ICA) and its branch, atypical and malignant histopathological features and tumor residue were risk factors related to the tumor recurrence. And can be used as predictors of the postoperative recurrence.