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

Abstract

Background: Most of the knowledge on spinal meningiomas is extrapolated from their intracranial counterparts, even though they are considered separate entities. This review aimed to systematically summarize studies covering different aspects of spinal meningiomas and their management. Methods: Databases were searched for all studies concerning spinal meningiomas dating from 2000 and onwards. When possible, a meta-analysis was performed. Results: Neurological outcomes of surgery were consistently favorable across studies, with a complication rate of 7.9% and 78.9% of the patients demonstrating good postoperative neurological function (McCormick score 1–2). The most relevant predictors of unfavorable outcomes were poor preoperative status, longer time from diagnosis to surgery, and surgery of recurrent tumors. The recurrence rate after surgery was estimated at 6%. Meta-analysis and/or survival analysis revealed that higher WHO grade (p < 0.001), higher Simpson grade (p < 0.001), ventral tumor location (p = 0.02), and male sex (p = 0.014) were all associated with higher odds of recurrence. However, the meta-analysis did not show any difference between Simpson grade 1 and grade 2 with respect to the odds of recurrence (p = 0.94). Surgery provided immediate and durable health-related quality-of-life improvement, as well as a high frequency of return to work. Conclusion: Spinal meningioma surgery is a relatively safe procedure with a low risk of tumor recurrence and high likelihood of favorable postoperative outcomes.

Pure endoscopic minimally invasive surgery with a non‑expandable tubular retractor for intradural extramedullary spinal tumors

“…Hence, the endoscopy approach is indicated for no more than 2 vertebral segments. It is difficult for the endoscopic approach to remove some tumors with specific locations and histology, such as ventral meningioma ( 32 ). The ventral meningioma usually has a wide base and limited surgical space, which makes it vulnerable to spinal cord injury due to repeated traction ( 33 ).…”

“…Therefore, for ventral meningioma, the endoscopic approach is not recommended, while traditional open surgery is recommended. Other ventral tumors or meningiomas at other locations (lateral, medial, or posterior) can be removed by the endoscopic approach ( 32 ). In addition, the endoscopic approach will increase the difficulty of repairing the dura mater and of achieving hemostasis ( 17 ).…”

Spontaneous spinal cord infarctions: a systematic review and pooled analysis protocol

“…Meta-analysis will only be performed for research questions where rigorous, homogeneous and sufficient data are available. A similar methodology has been described in several of our previous works 44–47…”

A Retrospective Cohort Study Evaluating the Comparative Effectiveness of Unilateral Hemilaminectomy and Bilateral Laminectomy in the Resection of Spinal Meningiomas

“…This suggests that resection of the dura, which is associated with higher rate of complications related to duraplasty, is not required. 2,14,35,36 In contrary, STR is the main predictor of tumor recurrence, which again highlights the importance of achieving GTR. 25,26,37 One more important fact is that resection in case of a recurrent tumor is one of the main factors for poor outcome after such surgery, 9,31 indicating the importance of avoiding it by achieving the goal of GTR in first surgery.…”

“…Surgical resection remains the gold standard, yielding favorable postoperative results regarding neurological and oncological outcomes. [1][2][3][4][5] Conventionally, laminectomy has been the preferred approach; however, the emergence of unilateral hemilaminectomy as a less invasive alternative has gained traction in recent years. [6][7][8][9] Unilateral hemilaminectomy involves minimal bone removal and muscle detachment from only one side, aiming to achieve comparable or even superior postoperative results through reduced surgical impact, decreased pain, quicker recovery, and improved long-term outcomes, such as prevention of postlaminectomy kyphosis.…”