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Abstract：
Meningiomas of the rolandic region are associated to high risk of postoperative motor deficits. This study discusses the factors affecting motor outcome and recurrences from the analysis of a monoinstitutional case series and eight studies from a literature review.
Data of 75 patients who underwent surgery for meningioma of the rolandic region were retrospectively reviewed. The analyzed factors included tumor location and size, clinical presentation, magnetic resonance imaging (MRI) and surgical findings, brain-tumor interface, extent of resection, postoperative outcome and recurrence. Eight studies from literature on rolandic meningiomas treated with or without intraoperative monitoring (IOM) were reviewed with the aim to define the impact of IOM on the extent of resection and motor outcome.
Among the 75 patients of the personal series, the meningioma was on the brain convexity in 34 (46%), at the parasagittal region in 28 (37%) and at the falx in 13 (17%). The brain-tumor interface was preserved in 53 cases (71%) at MRI and in 56 (75%) at surgical exploration. Simpson grade I resection was obtained in 43% of patients, grade II in 33%, grade III in 15% and grade IV in 9%. The motor function worsened postoperatively in 9 among 32 cases with preoperative deficit (28%) and in 5 among 43 with no preoperative deficit (11.5%); definitive motor deficit was evidenced in overall series at follow-up in 7 (9.3%). Patients with meningioma with lost arachnoid interface had significant higher rates of worsened postoperative motor deficit (p = 0.01) and seizures (p = 0.033). Recurrence occurred in 8 patients (11%). The analysis of the 8 reviewed studies (4 with and 4 without IOM) shows in the group without IOM higher rates of Simpson grades I and II resection (p = 0.02) and lower rates of grades IV resection (p = 0.002); no significant differences in postoperative immediate and long-term motor deficits were evidenced between the two groups.
Data from literature review show that the use of IOM does not affect the postoperative motor deficit Therefore, its role in rolandic meningiomas resection remains to be determined and will be defined in further studies.
Data of 75 patients who underwent surgery for meningioma of the rolandic region were retrospectively reviewed. The analyzed factors included tumor location and size, clinical presentation, magnetic resonance imaging (MRI) and surgical findings, brain-tumor interface, extent of resection, postoperative outcome and recurrence. Eight studies from literature on rolandic meningiomas treated with or without intraoperative monitoring (IOM) were reviewed with the aim to define the impact of IOM on the extent of resection and motor outcome.
Among the 75 patients of the personal series, the meningioma was on the brain convexity in 34 (46%), at the parasagittal region in 28 (37%) and at the falx in 13 (17%). The brain-tumor interface was preserved in 53 cases (71%) at MRI and in 56 (75%) at surgical exploration. Simpson grade I resection was obtained in 43% of patients, grade II in 33%, grade III in 15% and grade IV in 9%. The motor function worsened postoperatively in 9 among 32 cases with preoperative deficit (28%) and in 5 among 43 with no preoperative deficit (11.5%); definitive motor deficit was evidenced in overall series at follow-up in 7 (9.3%). Patients with meningioma with lost arachnoid interface had significant higher rates of worsened postoperative motor deficit (p = 0.01) and seizures (p = 0.033). Recurrence occurred in 8 patients (11%). The analysis of the 8 reviewed studies (4 with and 4 without IOM) shows in the group without IOM higher rates of Simpson grades I and II resection (p = 0.02) and lower rates of grades IV resection (p = 0.002); no significant differences in postoperative immediate and long-term motor deficits were evidenced between the two groups.
Data from literature review show that the use of IOM does not affect the postoperative motor deficit Therefore, its role in rolandic meningiomas resection remains to be determined and will be defined in further studies.
摘要：
目的：罗兰地区的脑膜瘤与术后运动障碍的高风险相关。本研究通过对单一机构案例系列的分析和对文献综述的八项研究，讨论了影响运动结果和复发的因素。
方法：回顾性分析75例接受手术治疗的罗兰地区脑膜瘤患者的资料。分析的因素包括肿瘤的位置和大小，临床表现,磁共振成像（MRI）和手术发现，脑肿瘤界面，切除范围,术后结果和复发。回顾了八项有关接受或不接受术中监测（IOM）治疗的罗兰脑膜瘤的文献研究，目的是确定IOM对切除程度和运动结果的影响。
结果：在个人系列的75名患者中，脑膜瘤在34（46％）的大脑凸度上，在矢状旁区28（37％）和13（17％）的镰状区。在MRI中保留了53例（71％）脑肿瘤界面，在手术探查中保留了56例（75％）。43％的患者获得了SimpsonI级切除，33%的II级，15%的III级和9%的IV级。32例术前有缺陷的患者中有9例（28％），而43例无术前缺陷的患者中有5例（11.5％），术后运动功能恶化；在随访的总体系列中有7例（9.3％）。蛛网膜界面丢失的脑膜瘤患者术后运动功能障碍（p=0.01）和癫痫发作（p=0.033）的发生率明显更高。复发8例（11%）。对8项综述研究（4项没有IOM和4项没有IOM）的分析显示，在没有IOM的组中，SimpsonI级和II级切除率较高（p=0.02），IV级切除率较低（p=0.002）；两组之间在术后即时和长期运动缺陷方面没有显着差异。
结论：来自文献综述的数据表明，使用IOM不会影响术后运动缺陷。其在罗兰脑膜瘤切除术中的作用尚待确定，并将在进一步的研究中确定。
方法：回顾性分析75例接受手术治疗的罗兰地区脑膜瘤患者的资料。分析的因素包括肿瘤的位置和大小，临床表现,磁共振成像（MRI）和手术发现，脑肿瘤界面，切除范围,术后结果和复发。回顾了八项有关接受或不接受术中监测（IOM）治疗的罗兰脑膜瘤的文献研究，目的是确定IOM对切除程度和运动结果的影响。
结果：在个人系列的75名患者中，脑膜瘤在34（46％）的大脑凸度上，在矢状旁区28（37％）和13（17％）的镰状区。在MRI中保留了53例（71％）脑肿瘤界面，在手术探查中保留了56例（75％）。43％的患者获得了SimpsonI级切除，33%的II级，15%的III级和9%的IV级。32例术前有缺陷的患者中有9例（28％），而43例无术前缺陷的患者中有5例（11.5％），术后运动功能恶化；在随访的总体系列中有7例（9.3％）。蛛网膜界面丢失的脑膜瘤患者术后运动功能障碍（p=0.01）和癫痫发作（p=0.033）的发生率明显更高。复发8例（11%）。对8项综述研究（4项没有IOM和4项没有IOM）的分析显示，在没有IOM的组中，SimpsonI级和II级切除率较高（p=0.02），IV级切除率较低（p=0.002）；两组之间在术后即时和长期运动缺陷方面没有显着差异。
结论：来自文献综述的数据表明，使用IOM不会影响术后运动缺陷。其在罗兰脑膜瘤切除术中的作用尚待确定，并将在进一步的研究中确定。
