Kliniğimizde Opere Edilen İntra-Kranial Menenjiom Olgularının Retrospektif Analizi
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Tarih
2024
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Necmettin Erbakan Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Kliniğimizde intra-kranial menenjiom tanısı ile opere edilen hastaların sonuçlarının, literatür ışığında retrospektif olarak değerlendirilmesi amaçlanmıştır.
Yöntem: Kasım 2014 ile Şubat 2023 yılları arasında Necmettin Erbakan Üniversitesi Tıp Fakültesi Beyin ve Sinir Cerrahisi kliniğinde opere edilen 101 hasta, cinsiyet, yaş, semptom ve bulgular, histopatolojik grade ve alt tip, tümör lokalizasyonu, takipte nüks varlığı, nüks sonrası uygulanan tedavi yaklaşımları, nüks ile histopatolojik tip, tümör lokalizasyonu, rezeksiyon evresi ilişkisi, patolojik grade ile cinsiyet, başvuru semptomları, nörolojik muayene, tümör lokalizasyonu ilişkisi, cerrahi sonrası komplikasyonlar ve nörolojik durum ve takipte sağ kalım açısından literatür ile kıyaslanarak incelenmiştir.
Bulgular: İntrakranial menenjiom nedeniyle opere ettiğimiz hastaların yaş ortalaması 54,58 ± 13,76 yıl olarak tespit edildi; %68,3’ü (n=69) kadın, %31,7’si (n=32) erkekti. Hastalarda en sık görülen semptom baş ağrısıydı (%60,8; n=61). Hastaların %53,5’inde (n=54) nörolojik muayenede bulgu saptanmazken, hastaların %46,5’inde (n=47) nörolojik muayenede bulgu saptandı. En sık kaydedilen nörolojik muayene bulguları %25,7 (n=26) ile parezi idi. Olgularımızda menenjiomların en sık yerleşim lokalizasyonu konveksite (%29,6) olarak tespit edildi. Vakaların %75,2’si grade I, %23,8’i grade II, %1’i grade III olarak tespit edilirken, en sık görülen histopatolojik alt tipler %33,6 ile meningotelyal ve %18,8 ile atipik menenjiomlar olarak saptandı. Olguların %50,5’ine Simpson evre 2, %23,8’ine Simpson evre 3, %25,7’sine Simpson evre 4 rezeksiyon uygulandığı tespit edildi. Hastaların %26,7’sinde nüks menenjiom izlendi; Simpson Evre 2 rezeksiyon yapılan hastalarda nüks gözlenmezken, Simpson evre 3 rezeksiyon uygulananlarda %8,3, Simpson evre 4 rezeksiyon yapılanlarda ise %96,2 nüks oranı görüldü. Bu durum, istatistiki olarak anlamlı bulundu; Simpson rezeksiyon evresi ile nüks arasında ilişki olduğu tespit edildi. Tümör lokalizasyonuna göre nüks gelişimi değerlendirildiğinde, en sık serebello-pontin köşede yerleşenlerde nüks görüldüğü (%75’inde) saptandı. Çalışmada, grade III menenjiom olgularının %100’ünde, grade II menenjiomların %38’inde ve grade I menenjiomların %22,4’ünde nüks izlendi. Olgular arasında, nörolojik muayenede bilinç bozukluğu bulgusu olan hastaların %75’inin grade II ve III menenjiom olduğu görüldü; bu durum istatistiksel olarak anlamlı bulundu; bu sonuç bize, bu hastalarda beyin invazyonunu düşündürmüştür. Ayrıca yüksek grade (II ve III grade) menenjiomların en fazla bulunduğu lokalizasyonlar, intraventriküler ve konveksite lokalizasyonları olarak tespit edildi. Vakaların %9,9’unda post-operatif komplikasyon görüldü; en sık görülen komplikasyon bos fistülü (%6) olarak tespit edildi. Takip süresi boyunca 2 hastamızda exitus görüldü. Post-operatif dönemde, menenjite bağlı sepsis nedeniyle bir olgu exitus oldu; post-operatif erken dönem mortalite oranımız %1 di. Post-operatif erken dönem değerlendirmede, vakaların %73’ünün nörolojik muayene bulgularında değişiklik olmazken, %22’sinde düzelme, %4’ünde ise kötüleşme saptandı.
Sonuç: Çalışmada elde edilen sonuçların, genel itibariyle, literatürdeki mevcut çalışmalarla benzer olduğu izlenmektedir. Çalışmamızın, %95’lik güven aralığında izlenen mevcut istatistiki sonuçları ile, ileride yapılacak çalışmalar için kaynak olabileceği değerlendirilmektedir.
Aim: The aim of this study was to retrospectively evaluate the outcomes of patients operated for intracranial meningioma in our clinic in light of the literature. Method: A total of 101 patients who underwent surgery for intracranial meningioma at the Department of Neurosurgery, Necmettin Erbakan University Faculty of Medicine, between November 2014 and February 2023 were included in the study. Patient characteristics such as gender, age, symptoms and signs, histopathological grade and subtype, tumor localization, presence of recurrence during follow-up, treatment approaches after recurrence, relationship between recurrence and histopathological type, tumor localization, and resection grade, as well as the correlation between pathological grade and gender, presenting symptoms, neurological examination findings, tumor localization, postoperative complications, neurological status, and survival during follow-up were evaluated and compared with the literature. Results: The mean age of the patients operated for intra-cranial meningioma was 54.58 ± 13.76 years; 68.3% (n=69) were female and 31.7% (n=32) were male. The most common symptom observed in patients was headache (60.8%, n=61). While neurological examination revealed no findings in 53.5% (n=54) of patients, neurological signs were detected in 46.5% (n=47) of patients. Paresis was the most frequently recorded neurological examination finding (25.7%, n=26). Meningiomas were most commonly localized in the convexity (29.6%). Grade I tumors accounted for 75.2% of cases, followed by grade II (23.8%) and grade III (1%). The most common histopathological subtypes were meningothelial (33.6%) and atypical meningiomas (18.8%). Simpson grade 2 resection was performed in 50.5% of cases, followed by Simpson grade 3 (23.8%) and Simpson grade 4 (25.7%). Recurrence was observed in 26.7% of cases, with the highest recurrence rate observed in patients who underwent Simpson grade 4 resection. There was a significant association between Simpson resection grade and recurrence. Recurrence was most commonly seen in meningiomas located in the cerebello-pontine angle (75%). The incidence of recurrence was highest in grade III meningiomas (100%), followed by grade II (38%) and grade I (22.4%). Among the cases, it was observed that 75% of patients with signs of altered consciousness in neurological examination had grade II and III meningiomas; this finding was found to be statistically significant; this result has led us to consider brain invasion in these patients. Additionally, high-grade meningiomas (grades II and III) were most commonly found in intraventricular and convexity locations. Postoperative complications were observed in 9.9% of cases, with cerebrospinal fluid fistula being the most common complication (6%). During follow-up, two patients died due to postoperative complications. The early postoperative mortality rate was 1%. In early postoperative assessment, 73% of cases showed no change in neurological examination findings, improvement was observed in 22%, and worsening was noted in 4%. Conclusion: The results obtained in this study are generally consistent with existing studies in the literature. The statistically significant findings of our study within a 95% confidence interval may evaluated as a reference for future studies.
Aim: The aim of this study was to retrospectively evaluate the outcomes of patients operated for intracranial meningioma in our clinic in light of the literature. Method: A total of 101 patients who underwent surgery for intracranial meningioma at the Department of Neurosurgery, Necmettin Erbakan University Faculty of Medicine, between November 2014 and February 2023 were included in the study. Patient characteristics such as gender, age, symptoms and signs, histopathological grade and subtype, tumor localization, presence of recurrence during follow-up, treatment approaches after recurrence, relationship between recurrence and histopathological type, tumor localization, and resection grade, as well as the correlation between pathological grade and gender, presenting symptoms, neurological examination findings, tumor localization, postoperative complications, neurological status, and survival during follow-up were evaluated and compared with the literature. Results: The mean age of the patients operated for intra-cranial meningioma was 54.58 ± 13.76 years; 68.3% (n=69) were female and 31.7% (n=32) were male. The most common symptom observed in patients was headache (60.8%, n=61). While neurological examination revealed no findings in 53.5% (n=54) of patients, neurological signs were detected in 46.5% (n=47) of patients. Paresis was the most frequently recorded neurological examination finding (25.7%, n=26). Meningiomas were most commonly localized in the convexity (29.6%). Grade I tumors accounted for 75.2% of cases, followed by grade II (23.8%) and grade III (1%). The most common histopathological subtypes were meningothelial (33.6%) and atypical meningiomas (18.8%). Simpson grade 2 resection was performed in 50.5% of cases, followed by Simpson grade 3 (23.8%) and Simpson grade 4 (25.7%). Recurrence was observed in 26.7% of cases, with the highest recurrence rate observed in patients who underwent Simpson grade 4 resection. There was a significant association between Simpson resection grade and recurrence. Recurrence was most commonly seen in meningiomas located in the cerebello-pontine angle (75%). The incidence of recurrence was highest in grade III meningiomas (100%), followed by grade II (38%) and grade I (22.4%). Among the cases, it was observed that 75% of patients with signs of altered consciousness in neurological examination had grade II and III meningiomas; this finding was found to be statistically significant; this result has led us to consider brain invasion in these patients. Additionally, high-grade meningiomas (grades II and III) were most commonly found in intraventricular and convexity locations. Postoperative complications were observed in 9.9% of cases, with cerebrospinal fluid fistula being the most common complication (6%). During follow-up, two patients died due to postoperative complications. The early postoperative mortality rate was 1%. In early postoperative assessment, 73% of cases showed no change in neurological examination findings, improvement was observed in 22%, and worsening was noted in 4%. Conclusion: The results obtained in this study are generally consistent with existing studies in the literature. The statistically significant findings of our study within a 95% confidence interval may evaluated as a reference for future studies.
Açıklama
Anahtar Kelimeler
İntrakranial, Intracranial, menenjiom, meningioma, retrospektif analiz, retrospective analysis
Kaynak
WoS Q Değeri
Scopus Q Değeri
Cilt
Sayı
Künye
Döğer, B. M. (2024). Kliniğimizde Opere Edilen İntra-Kranial Menenjiom Olgularının Retrospektif Analizi. (Yayınlanmamış tıpta uzmanlık tezi) Necmettin Erbakan Üniversitesi, Tıp Fakültesi Cerrahi Tıp Bilimleri Bölümü Beyin Cerrahisi Anabilim Dalı, Konya.
