Clinical features and prognostic factors in spinal meningioma surgery from a multicenter study

Abstract

Meningiomas are benign tumors that are treated surgically. Local recurrence is likely if the dura is preserved, and en bloc tumor and dura resection (Simpson grade I) is recommended. In some cases the dura is cauterized and preserved after tumor resection (Simpson grade II). The purpose of this study was performed to analyze clinical features and prognostic factors associated with spinal meningioma, and to identify the most effective surgical treatment. The subjects were 116 patients (22 males, 94 females) with spinal meningioma who underwent surgery at seven NSG centers between 1998 and 2018. Clinical data were collected from the NSG database. Pre- and postoperative neurological status was defined using the modified McCormick scale. The patients had a mean age of 61.2 ± 14.8 years (range 19–91 years) and mean symptom duration of 11.3 ± 14.7 months (range 1–93 months). Complete resection was achieved in 108 cases (94%), including 29 Simpson grade I and 79 Simpson grade II resections. The mean follow-up period was 84.8 ± 52.7 months. At the last follow-up, neurological function had improved in 73 patients (63%), was stable in 34 (29%), and had worsened in 9 (8%). Eight patients had recurrence, and recurrence rates did not differ significantly between Simpson grades I and II in initial surgery. Kaplan–Meier analysis of recurrence-free survival showed that Simpson grade III or IV, male, and dural tail sign were significant factors associated with recurrence (P < 0.05). In conclusion, Simpson I resection is anatomically favorable for spinal meningiomas. Younger male patients with a dural tail and a high-grade tumor require close follow-up. The tumor location and feasibility of surgery can affect the surgical morbidity in Simpson I or II resection. All patients should be carefully monitored for long-term outcomes, and we recommend lifelong surveillance after surgery.

Functional Outcome in Spinal Meningioma Surgery and Use of Intraoperative Neurophysiological Monitoring

“…Even though spinal meningiomas (SM) are rare, they are among the most frequent intradural extramedullary tumors, representing about 1.2–12% of all meningiomas. SM constitute one-third of primary spinal tumors and 25–46% of all intradural spinal tumors [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 ].…”

“…Most SM are WHO grade 1, with higher grades (2 to 3) reported in 1.5–8.5% of cases [ 7 , 10 , 11 , 12 , 13 , 14 , 15 , 16 ]. Their distribution along the spinal axis varies, but most (67–84%) are located within the thoracic region [ 1 , 2 , 3 , 4 , 6 ]. The incidences of SM in the cervical and lumbar region are 14–27% and 2–14%, respectively [ 1 , 5 , 16 ].…”

“…The primary treatment option is microsurgical resection, which aims to achieve complete tumor removal and spinal cord decompression, thus preventing further neurological deterioration [ 1 , 4 , 17 , 18 ]. Follow-up (FU) imaging is also required.…”

“…Advancements in minimally invasive techniques necessitate studies of larger cohorts of patients undergoing open microsurgical techniques for future comparison [ 1 ]. Furthermore, a study of long-term outcomes is necessary to determine the optimum treatment strategy [ 4 ].…”

Minimally Invasive Tubular Retractor Surgery for Intradural Extramedullary Spinal Tumor Reduces Postoperative Degeneration of Paraspinal Muscle

“…In the meta-analysis of Barber et al, Simpson grade I excision of intradural meningioma was evidenced to have increased unexpected neurological deficits and complication rates. 26 The recurrence rates between Simpson grade I and II excisions were not significantly different in Barber et al and Kobayashi et al 26,27 We aimed for primary dural closure in our open surgery and MIS to avoid complications including pseudomeningocele or CSF leak. In our cohort, we observed a comparable complete excision rate in the MIS group and the number of recurrences or residual tumors was not significantly different.…”