Age at Diagnosis and Baseline Myelomalacia Sign Predict Functional Outcome After Spinal Meningioma Surgery

Abstract

Objective: Spinal meningioma (SM) accounts for 12% of all meningiomas. Clinical and immunohistochemical factors were analyzed with regard to functional outcome, surgical adverse events, and tumor recurrence.Methods: One-hundred and twenty-three consecutive SM patients underwent surgery and were retrospectively reviewed with regard to demographic parameters, imaging features, neurological function, and immunohistochemical items. Neurological function was graded according to the Modified McCormick Scale (MMS) and dichotomized as “good (grade I + II)” and “poor (grade III–V)” function.Results: One-hundred and fourteen (92.7%) WHO grade I and 9 (7.3%) WHO grade II SM were included in this study. Univariate analysis identified a baseline T2 hyperintensity of the spinal cord, baseline symptom duration ≥4 weeks, age ≥66 years, and dural tail sign as predictors of poor MMS. Baseline T2 hyperintensity of the spinal cord [Odds ratio (OR) = 13.3, 95% CI = 3.4–52.1, p < 0.001] and age ≥66 years (OR = 10.3, 95% CI = 2.6–41.1, p = 0.001) were independent predictors of a poor MMS grade at discharge after SM surgery in the multivariate binary logistic regression analysis. The 12- and 24-month recurrence-free survival rates were 98.7 % (1/80) and 94.7% (2/38), respectively. In those patients with tumor recurrence of the SM, highly increased MIB-1 (≥5%) labeling indices were observed.Conclusion: Baseline T2 hyperintensity, especially in the elderly patients, is a strong predictor of poorer recovery after spinal meningioma surgery. SMs with high proliferative activity should be followed-up closely despite maximal safe resection.

Timing of Resection of Spinal Meningiomas and Its Influence on Quality of Life and Treatment

“…Furthermore, patients in the cohort with severe symptoms were older, had more frequent tumors in the thoracic spine, with higher spinal canal occupancy ratio and spinal cord edema. The impact of the spinal canal ratio on neurological deficits was also demonstrated in previously published studies [2,20,[23][24][25][26]. These all seem to be risk factors for developing more severe deficits or a delay in diagnostics [20].…”

Current Knowledge on Spinal Meningiomas—Surgical Treatment, Complications, and Outcomes: A Systematic Review and Meta-Analysis (Part 2)

“…Patients with ventral spinal meningiomas may hence carry a higher risk of complications [ 41 ]. One study found significant ties between CSF fistula formation and ventral tumor location, with an odds ratio (OR) estimated at 10.5 [ 47 ].…”

“…Other factors significantly associated with an increased risk of perioperative complications were obesity [ 47 , 48 ] (OR: 3.2 in one study [ 49 ]), surgery for recurrent tumors [ 48 , 49 , 50 ], surgeon inexperience [ 48 ], and tumor calcification [ 30 ]. Additionally, longer operations were associated with an increased risk of postoperative CSF leak [ 48 ].…”

“…In total, 5 of the 72 patients in the Simpson grade 2 group (7%) and 2 of the 46 in the Saito group (4%) developed CSF leaks. In one study, CSF leaks could neither be associated to Simpson grade (1 vs. 2), nor to the number of spinal segments involved [ 47 ]. Two studies found no difference in the complication rates of unilateral and bilateral laminectomies [ 25 , 26 ].…”

Proliferative Potential, and Inflammatory Tumor Microenvironment in Meningioma Correlate with Neurological Function at Presentation and Anatomical Location—From Convexity to Skull Base and Spine

“…Clinical data including age, sex, neurological functioning, presence of symptomatic epilepsy, Modified McCormick (MMS) scale in spinal meningiomas, comorbidities, Karnofsky Performance Status (KPS), body mass index (BMI), anatomic location, WHO grading based on postoperative neuropathological investigation, immunohistochemical analysis, extent of meningioma resection based on Simpson grading system according to the European Association of Neuro-Oncology (EANO) (Simpson grade I–III = gross total resection, Simpson grade IV = subtotal resection, and Simpson grade V = biopsy), and postoperative follow-up data were saved into a computerized database (SPSS, version 27 for Windows, IBM Crop., Armonk, NY, USA) [ 16 , 25 ]. Modified McCormick scale was dichotomized into “good” (I + II) and “poor” (III–V) as described previously [ 26 ]. Anatomical location was dichotomized into cranial and spinal meningioma.…”