Clinical characteristics and long-term outcomes for patients who undergo cytoreductive surgery for thoracic meningiomas: a retrospective analysis

Abstract

OBJECTIVE Primary spinal meningiomas represent a rare indolent neoplasm usually situated in the intradural-extramedullary compartment. They have a predilection for afflicting the thoracic spine and most frequently present with sensory and/or motor symptoms. Resection is the first-line treatment for symptomatic tumors, whereas other clinical factors will determine the need for adjuvant therapy. In this study, the authors aimed to elucidate clinical presentation, functional outcomes, and long-term outcomes in this population in order to better equip clinicians with the tools to counsel their patients. METHODS This is a retrospective analysis of patients treated at the authors’ institution between 1998 and 2018. All patients with thoracic meningiomas who underwent resection and completed at least one follow-up appointment were included. Multiple preoperative clinical variables, hospitalization details, and long-term outcomes were collected for the cohort. RESULTS Forty-six patients who underwent resection for thoracic meningiomas were included. The average age of the cohort was 59 years, and the median follow-up was 53 months. Persistent sensory and motor symptoms were present in 29 patients (63%). Fifteen lesions were ventrally positioned. There were 43 WHO grade I tumors, 2 WHO grade II tumors, and 1 WHO grade III tumor; the grade III tumor was the only case of recurrence. The median length of hospitalization was 4 days. Seventeen patients (37%) were discharged to rehabilitation facilities. Thirty patients (65.2%) experienced resolution or improvement of symptoms, and there were no deaths within 30 days of surgery. Only 1 patient developed painful kyphosis and was managed medically. Ventral tumor position, new postoperative deficits, and length of stay did not correlate with disposition to a facility. Age, ventral position, blood loss, and increasing WHO grade did not correlate with length of stay. CONCLUSIONS Outcomes are overall favorable for patients who undergo resection of thoracic meningiomas. Symptomatic patients often experience improvement, and patients generally do not require significant future operations. Tumors located ventrally, while anatomically challenging, do not necessarily herald a significantly worse prognosis or limit the extent of resection.

Current Knowledge on Spinal Meningiomas Epidemiology, Tumor Characteristics and Non-Surgical Treatment Options: A Systematic Review and Pooled Analysis (Part 1)

“…Neurofibromatosis type 1 (NF1) was reported in one patient [ 57 ], while in another study 14 of 103 patients were classified as having either NF1 or NF2 without specifying the distribution between the two diagnoses [ 58 ]. One spinal meningioma patient was diagnosed as having Von Hippel-Lindau syndrome (VHL) [ 59 ]. The rarely reported concurrences of spinal meningiomas with phacomatoses other than NF2 seem to be the results of coincidence rather than true associations.…”

“…The uses of these two modalities were reported for 58.4% and 40% of the tumors, respectively. Only four patients received other treatments: one received chemotherapy alone [ 67 ], one had combined chemo- and radiotherapy [ 67 ], one had combined Receptor Tyrosine Kinase inhibitor and radiotherapy [ 59 ], and the last one received brachytherapy [ 82 ].…”

“…Contradictory outcomes were also reported in studies offering adjuvant therapy. While some reported no complications or recurrence of tumors [ 36 , 62 , 88 ], others encountered major adverse events and did not benefit from the treatment [ 37 , 53 , 59 , 89 , 90 ]. Hence, no clear conclusions can be drawn regarding the use of adjuvant radiation for the targeted patient groups.…”

Clinical features and surgical outcomes of primary spinal anaplastic meningioma: a cases series and literature review

“…A systematic review concluded the average age of spinal meningiomas was 62.6 years old after adjusting the sample size of various studies ( 20 ). The median age of our patients was 25 (range, 13–46) years, while the median age of literature cases was 55 (range, 47–68) years ( 8 , 9 , 12 , 13 ). Both samples were small and apparently heterogenous, thereby offering no consistent information concerning susceptible age.…”

“…However, PSAMs seemed to occur more frequently in cervical region (66.7%) followed by cervicothoracic (16.7%) and thoracolumbar areas (16.7%) in our sample. In literature, four PSAMs were all found at thoracic level ( 7 - 9 , 12 ).…”