Spinal Meningioma: Relationship Between Histological Subtypes and Surgical Outcome?

Abstract

Intraspinal meningiomas are slow growing benign tumors that produce indolent neurological deficits, which are often reversible following operation. It is unclear, if there is a correlation between postoperative neurological restoration and histopathological parameters. The aim of the present work was to seek for existence of such parameters. Retrospectively, we reviewed the charts of 33 patients with spinal meningiomas who were operated on from January 1980 through December 1995. Histological classification was performed according to WHO criteria. Laminoplasty or hemilaminoplasty was performed in 29 patients (88%) and suboccipital craniotomy with cervical laminoplasty in 4 patients (12%). Mean age of the 30 women (91%) and the 3 men (9%) was 63+/-20 years (range 22-88). Spinal meningiomas were of high-cervical location in 9 (27%) and of low-cervico-thoracic location in 24 (73%) patients. Tumor position was laterally in 19 (58%), posteriorly in 8 (24%) and anteriorly in 6 (18%) patients. Histological classification was psammomatous in 22 (66%), fibroblastic in 7 (22%) and meningothelial in 4 (11%) patients. Following tumor resection, neurological deficits resolved in 26 of 33 patients (79%) and worsened in 7 of 33 patients (21%) all of the latter had meningiomas of the psammomatous type. Resection of psammomatous meningiomas of the spine is associated with a less favorable neurological outcome postoperatively than resection of spinal meningiomas of other pathological subtypes. Posterior or lateral tumor position in the spinal canal, location below C4, age less than 60 years, and duration of preoperative symptoms seem to be correlated with a good outcome.

Effects of sex on the incidence and prognosis of spinal meningiomas: a Surveillance, Epidemiology, and End Results study

“…23,24 A tendency toward incidence later in life has been described, and in the present study, there was an exponential trend of incidence with respect to age. 8,17,18 These tumors were most frequently benign (96% of cases), supporting the known epidemiology of these lesions, with more advanced staging being much less common. 18 Survival distributions were calculated for various predictive factors; age, sex, marital status, primary site, size quartile, treatment modality, and malignant character were considered.…”

“…8,17,18 These tumors were most frequently benign (96% of cases), supporting the known epidemiology of these lesions, with more advanced staging being much less common. 18 Survival distributions were calculated for various predictive factors; age, sex, marital status, primary site, size quartile, treatment modality, and malignant character were considered. The factors that had statistically significant hazard ratios for mortality according to the Cox model were age, sex, and size quartile.…”

“…The differences in mortality rates with respect to benign versus malignant status were not significant in this work, potentially because of the heterogeneity in diagnostic and treatment modalities, although other studies have suggested lesser survival among patients with higher-grade lesions. 18 Radiotherapy for meningiomas is occasionally initiated without histological confirmation or for cases in which various factors render biopsy or excision impossible, and unfortunately, these cases were not considered in this study; this mostly affects the results for the outcomes of the radiotherapy-alone group. Such a modality is implemented when surgical treatment is contraindicated 15 or as an adjunct to resection of a malignant or progressively enlarging benign lesion.…”

“…They present in patients most frequently with both local pain and motor dysfunction, although a median of 38.5% (range 4%-61%) of patients will have an identifiable degree of sphincter dysfunction upon detection. 4,5,7,8,12,[14][15][16][18][19][20]22 When neurologically symptomatic, these lesions normally require surgical resection because slow growth in the confined spinal canal most frequently leads to thoracic myelopathy. Serial observation and stereotactic radiosurgery have been implemented for incidental lesions, although the durability and adverse effects of such management have not yet been established.…”

Surgical resection without dural reconstruction of a lumbar meningioma in an elderly woman

“…Approximately 80% of spinal cord meningiomas occur in the thoracic spine, followed in frequency by the cervical and lumbar regions [3,7,10,13]. They primarily affect middle-age woman, and little is known about their outcome in patients 70 years and older because the number of reported cases is small [8,12]. The goal of treatment is complete surgical resection.…”