Clinical Aspects of Spinal Meningiomas: a Review

Abstract

Spinal meningiomas are found in all age groups, predominantly in women aged over 50 years. The clinical symptoms of this condition may range from mild to significant neurological deficit, varying widely depending on the location, position in relation to the spinal cord, size and histological type of the tumor. Magnetic resonance imaging is the diagnostic tool of choice because it shows the location, size, the axial position of the tumor, and the presence of concomitant conditions such as spinal malformations, edema or syringomyelia.  According to the degree of malignancy, the World Health Organization divides meningiomas into three grades: grade I - benign; grade II – atypical, and grade III - malignant. The goal of the surgery is total resection which is achievable in 82%–98% of cases. Advances in radiosurgery have led to its increased use as primary or adjunct therapy. The current paper aims to review the fundamental clinical as-pects of spinal meningiomas such as their epidemiology, clinical presentation, histological characteristics, diagnostics, and management.

Characterization and Treatment of Spinal Tumors

“…Magnetic resonance imaging (MRI) is the imaging modality of choice for spinal meningiomas because the size, location, and axial position can be identified [ 21 ]. The lesion is usually either iso- or hypointense on T1 and mildly hyperintense on T2 weighted MRI.…”

“…CT myelography can be used in conjunction with MRI to identify the presence of calcification in the lesion or in cases where MRI is contraindicated. Spinal angiography is often utilized before surgical intervention of spinal meningiomas in the thoraco-lumbar spine to identify the artery of Adamkiewicz in relation to the lesion [ 21 ]. Spinal angiography is also used in certain cases preoperatively for the embolization of tumor-feeding vessels to reduce intraoperative bleeding and tumor volume.…”

Visión general sobre meningiomas: bases genéticas, evaluación clínica y estrategias terapéuticas

“…Asimismo, se recomienda posterior a resección de un meningioma maligno (grado III), sin importar el grado de resección adquirido. En tumores grado I o II con resección subtotal y en el escenario de recurrencia de un tumor previamente disecado, también es recomendado el uso de RT (1,3,12). Como es bien conocido, la radiación ionizante ejerce su efecto letal mediante la apoptosis celular (12).…”

“…En tumores grado I o II con resección subtotal y en el escenario de recurrencia de un tumor previamente disecado, también es recomendado el uso de RT (1,3,12). Como es bien conocido, la radiación ionizante ejerce su efecto letal mediante la apoptosis celular (12). Existen distintas técnicas que se han desarrollado, como la radiocirugía estereostática (RTS), la radioterapia fraccionada (RTF) y la radioterapia con intensidad modulada (IMRT); sin embargo, no existe evidencia de cuál es superior a la otra, y se requiere de ciertas características tumorales para el empleo de estas técnicas (6,13,14).…”

Letter to the Editor : Extramedullary Intradural Calcified Meningiomas Surgery in Limited Resources Context

“…However, they are also found in people under 50 years of age usually associated with a poor prognosis 2) . The signs can be confused with other diseases in elderly people and delay the diagnosis 1) . The delay in diagnosis is also due to the unavailability and accessibility of CT scan and MRI in countries with limited resources such as ours.…”