Functional outcome after surgical treatment of spinal meningioma

Hohenberger, Christoph; Gugg, Christine; Schmidt, Nils Ole; Zeman, Florian; Schebesch, Karl‐Michael

doi:10.1016/j.jocn.2020.05.042

Cited by 28 publications

(27 citation statements)

References 21 publications

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“…Compared to the preoperative assessment, surgery was followed by improvement of motor deficits, sensory deficits, gait disturbances, bladder dysfunction and pain. This is largely on par with the few previous studies that have analyzed neurological outcomes after spinal meningioma surgery with a long follow-up and in a large population [36,37]. We also found that time to surgery predicted improvement in mMCs, with an OR of 0.85, indicating that the concept of "time is spinal cord" is applicable to slow growing spinal tumors as well.…”

Section: Discussionsupporting

confidence: 79%

“…Particularly in these cases, aggressive treatment of the dura to achieve Simpson grade 1 will need to be weighed against the increased risk of neurological complications and cerebrospinal fluid leakage [40]. Our long-term tumor control was more than adequate, with two cases of tumor recurrence following a Simpson grade 2 (n = 2) resection (of which one tumor bordered WHO grade 2), and four cases of tumor growth following a Simpson grade 4 resection, which corresponds well with the rates described in the literature [36]. However, recent studies with follow-up times > 10 years suggest that Simpson grade 2 resection may be associated with higher tumor recurrence than previously believed [6,[8][9][10][11]41].…”

Section: Discussionsupporting

confidence: 78%

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Long-Term Follow-Up and Predictors of Functional Outcome after Surgery for Spinal Meningiomas: A Population-Based Cohort Study

Pettersson-Segerlind

Fletcher‐Sandersjöö

Tatter

et al. 2021

Cancers

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Spinal meningiomas are the most common adult primary spinal tumor, constituting 24–45% of spinal intradural tumors and 2% of all meningiomas. The aim of this study was to assess postoperative complications, long-term outcomes, predictors of functional improvement and differences between elderly (≥70 years) and non-elderly (18–69 years) patients surgically treated for spinal meningiomas. Variables were retrospectively collected from patient charts and magnetic resonance images. Baseline comparisons, paired testing and regression analyses were used. In conclusion, 129 patients were included, with a median follow-up time of 8.2 years. Motor deficit was the most common presenting symptom (66%). The median time between diagnosis and surgery was 1.3 months. A postoperative complication occurred in 10 (7.8%) and tumor growth or recurrence in 6 (4.7%) patients. Surgery was associated with significant improvement of motor and sensory deficit, gait disturbance, bladder dysfunction and pain. Time to surgery, tumor area and the degree of spinal cord compression significantly predicted postoperative improvement in a modified McCormick scale (mMCs) in the univariable regression analysis, and spinal cord compression showed independent risk association in multivariable analysis. There was no difference in improvement, complications or tumor control between elderly and non-elderly patients. We concluded that surgery of spinal meningiomas was associated with significant long-term neurological improvement, which could be predicted by time to surgery, tumor size and spinal cord compression.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionsupporting

confidence: 78%

Long-Term Follow-Up and Predictors of Functional Outcome after Surgery for Spinal Meningiomas: A Population-Based Cohort Study

Pettersson-Segerlind

Fletcher‐Sandersjöö

Tatter

et al. 2021

Cancers

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“…The endoscope can obviate the use of much more complex anterior routes to the spine, often associated with postoperative spinal deformity and the need for adjunctive fusion surgery, allowing for visualization and removal of the ventrally located part of the tumor, with minimal retraction of the spinal cord. Endoscopic surgery may result equally effective in terms of extent of resection and with similar morbidity compared to open techniques [30,66] . The safety of spinal meningiomas removal is increased by the use of intraoperative neuromonitoring that enables the continuous evaluation of the sensory and motor functions of the spinal cord by means of somatosensory-evoked potentials, motor evoked potentials, and D-waves [66] .…”

Section: Endoscope-assisted Surgerymentioning

confidence: 99%

“…Endoscopic surgery may result equally effective in terms of extent of resection and with similar morbidity compared to open techniques [30,66] . The safety of spinal meningiomas removal is increased by the use of intraoperative neuromonitoring that enables the continuous evaluation of the sensory and motor functions of the spinal cord by means of somatosensory-evoked potentials, motor evoked potentials, and D-waves [66] . Therefore, intraoperative neuromonitoring should be considered as part of spinal meningiomas surgery, regardless of the surgical approach.…”

Section: Endoscope-assisted Surgerymentioning

confidence: 99%

Meningiomas: criteria for modern surgical indications

Cappabianca¹,

d’Avella²,

Cavallo³

et al. 2020

Mini-invasive Surg

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The contemporary management of meningiomas is the result of the continuous evolution of neurosurgical techniques, along with the refinement of dedicated instrumentations. Above all, it is the magnification of the surgical view, thanks to the microscope and the endoscope, and their advancements, which allowed the improvement of surgical outcomes, in terms of both extent of resection and morbidity rates. Because of the benign nature of the vast majority of meningiomas, complete tumor resection is curative, and it is the gold-standard treatment. However, in the case of high risk of surgical morbidity, a less aggressive surgical treatment may be justified, also upon tailored analysis of the meningiomas’ biological behavior and the improvements in postoperative strategies. The endoscopic technique plays a role, as a unique visualization tool or in combination with the microscope, in granting so-called maximum allowed resection. Considering the above, the most challenging task confronting modern meningioma surgery remains the selection of the most appropriate surgical approach, the latter greatly depending on location, anatomic tumor features, and relationships with critical neurovascular structures. Herein, we present a cogent analysis of the modern multifaceted indications for the endoscopic treatment of meningiomas, with a glimpse into the adjacent fields.

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“…The negligible oncological benefit of an aggressive surgical strategy that includes a wide removal of the dural attachment does not seem to outweigh the risk of surgical complications and patients' morbidity, especially for ventral and lateral spinal meningiomas. For this reason, there has been an attitude shift toward less aggressive resections, with the goal of minimizing morbidity [6][7][8][9] . The safety of meningiomas surgery is increased by the use of multimodal neuromonitoring: somatosensory-evoked potentials, motor evoked potentials, and D-waves provide the opportunity to assess the functional integrity of the spinal cord during surgery, bearing the risk of neurological complications.…”

Section: Introductionmentioning

confidence: 99%

The role of Vitom-3D in the management of spinal meningiomas: review of the literature and illustrative case

d’Avella¹,

Sacco²,

Somma³

et al. 2020

Mini-invasive Surg

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The favorable outcome generally associated with spinal meningioma surgery is the result of the continuing refinement of the surgical technique, the use of intraoperative neuromonitoring, and a better understanding of the tumor biological behavior. Among all the technological advancements, visualization tools are the keys to any successful surgical procedure. The operating microscope is the gold standard in all neurosurgical procedures. In recent years, high-definition exoscope systems have entered the field of neurosurgery, as another tool in the armamentarium of the contemporary neurosurgeon. After initial experiences and technical improvements, the exoscope has proven to be best suited for spinal procedures. This study aims to briefly review the exoscope journey in neurosurgery, with a special focus on spinal meningioma surgery. Benefits and limitations are analyzed and an illustrative case is reported. Spinal meningiomas removal under exoscope visualization has proven to be feasible, efficient, and safe. Indication for the use of the exoscope greatly depends on meningioma size, consistency, relationship to surrounding neurovascular structures, and the surgeon's experience. Switching to the operating microscope, if deemed safer, should always be considered.

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Functional outcome after surgical treatment of spinal meningioma

Cited by 28 publications

References 21 publications

Long-Term Follow-Up and Predictors of Functional Outcome after Surgery for Spinal Meningiomas: A Population-Based Cohort Study

Long-Term Follow-Up and Predictors of Functional Outcome after Surgery for Spinal Meningiomas: A Population-Based Cohort Study

Meningiomas: criteria for modern surgical indications

The role of Vitom-3D in the management of spinal meningiomas: review of the literature and illustrative case

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