无脑膜附着的脑实质内或皮层下脑膜瘤的临床特点及手术 (附 4 例临床报告及文献复习).

Objective To investigate the clinical, imaging and histopathological features of intracerebral parenchymal or subcortical meningioma without meningeal attachment. Methods The clinical, imaging, and histopathological characteristics of 4 patients with subcortical meningioma without meningeal attachment who underwent surgical treatment at Hainan Provincial People's Hospital from December 2019 to December 2022 were analyzed retrospectively. The principles of surgical management, surgical efficacy, and long-term follow-up results were summarized in conjunction with literature. Results The most common site for all patients was the frontal and parietal lobes, with 3 cases having cystic and solid lesions. Epilepsy was a common symptom before and after surgery. Three dimensional magnetic resonance imaging(MRI)showed that all tumors were located in the brain, and preoperative MRI, as well as intraoperative and postoperative pathology, confirm the absence of dural attachment. 4 patients underwent total resection, two were WHO grade Ⅰ, two were WHO grade Ⅱ, one had postoperative recurrence of atypical meningioma, one had no postoperative radiotherapy, and three received postoperative radiotherapy. After an average follow-up of 1. 5 years, 3 cases survived. Conclusions Intracortical or subcortical meningiomas without meningeal attachment are easily misdiagnosed before surgery. Peritumoral edema in some subcortical or subcortical meningiomas occurs in areas where the lesion adheres to surrounding brain tissue, not surrounding the entire tumor surface. MRI spectroscopy and other features may be helpful in distinguishing. WHO grade Ⅱ atypical meningiomas have a high rate of proliferation, invasion of brain parenchyma, and a high probability of recurrence. Surgical treatment is the first choice, and complete tumor resection is the most important factor in preventing tumor recurrence. For atypical or malignant meningiomas, radiotherapy is recommended immediately after initial operation. [ABSTRACT FROM AUTHOR]