Prognosis And Recurrence Of Parasellar Meningiomas After Microsurgical Resection And Thier Prognostic Factors: A 134-cases Report

Object:To study long-term neurological function outcome, quanty of life and tumor recurrence or progression of parasellar menningiomas after microsurgical resection. Analyse possible prognostic factors that may affect the postoperater visual acuity recovery of preoperater visual impairment patients and recurrence of tumor.Material and Method:Retrospectively analyzed clinical data and follow-up date in a consecutive series of 134 patients of parasellar meningiomas who underwent microsurgical treatment at Neurosurgical Department of XiangYa Hospital between 1985 and 2009 by Professor Yuan Xianrui. The main presenting symptoms of the patients were visual impairment in 78, headache in 70 and epilepsy in 39 cases, and the duration of symptoms was between 0.25 and 156 months(mean 21.5 months). The tumor size was 10-105mm(mean 52.5±15.6mm).40 cases resected via a orbital-zygomatic-infratemporal approach and 89 cases via a pterional or extended pterional approach,5 cases subfrontal approach. Detailed record the recovery of all patients after microsurgery and neurological function, quality of life, MRI of all follow-up patients in a registration form. Univariate analysis possible prognostic factors that may affect the postoperater visual acuity recovery of preoperater visual impairment patients and recurrence of tumor by statistics soft.Results:Of all the cases,109 cases (82%) reached total resection (Simpson gradeⅠandⅡ) and without postoperative mortality.56 cases of invading the canvernous sinus, of which 39 cases (69.6%) total resected, another 78 cases of no CS invasion 70 cases (89.7%) total resected.There are 116 cases have follow-up, and mean followe-up period was 5.8 years(0.25y-18y), and 64 patients had followed-up for more than 5 years. The mean quality of life score (KPS) was 91.9,89 (85%) patient regained full daily activity (KPS Score 80-100) and 17 (15%) patients were able to live at home and care for most personal needs (KPS Score 60-70). Oculomotor paralysis rate was 6.0%. Epilepsy saw in 6.9% paitents. Postoperatively, amone 78 paitients of preoperatively visual impairment, visual acuity improved in 43 cases (55.3%), unchanged in 33 cases (42.3%), and deteriorated in 2 cases(2.7%), a newly deteriorated was observed on long-term follow-up in 6 patients (5.1%) accompany by tumor recurrence or progreesion. Clinical and MR imaging data revealed tumor recurrence after total resection in 12 cases (12.5%), and the rate of tumor progression after subtotal resection was 57%.21 cases of subtotal resection after 7 years follow-up, progression found in 12 cases(57%). Gamma knife treat for 7 case with 1 progression. Other 14 cases without any treatment,11 cases progressed. The progression rate of group gmma knife was significant low than group without any treatment(p<0.05).Univariate analysis showed that visual prognosis was favourably affect by no optic nerve encased by tumor, short time of symptom duration; and tumor recurrence was favourable affect by high pathologic grade of WHO, with skull base bone destruction, with invation of CS (P<0.05).Conclusion:1. The patient of parasellar meningiomas undergoing microsurgical resection can get a good long-term function outcome. For most of patients, total removal by microsurgery is the first choice.2. The recovery of preoperation visual impairment is possible for parasellar meningiomas, visual prognosis was favourably affect by no optic nerve encased by tumor, short time symptom duration.3. The recurrence was favourable affect by high pathologic grade of WHO, with skull base bone destruction, with invation of CS.4. The life quality of subtotal resected patients were worse than that of total resected. Gmma knife was a reliable treatment for patient of tumor subtoal resected.