Spinal Meningioma Surgery in Elderly Patients With Paraplegia or Severe Paraparesis

Sacko, Oumar; Haegelen, Claire; Mendes, Vivien; Brenner, Antônio Sérgio; Sesay, Musa; Brauge, David; Lagarrigue, J; Loiseau, Hugues; Roux, Franck‐Emmanuel

doi:10.1227/01.neu.0000338427.44471.1d

Cited by 38 publications

(54 citation statements)

References 30 publications

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“…Gerszten et al [9] reported radiographic control of mainly recurrent meningiomas with radiosurgery; however, more studies are needed with longer follow-up periods. Advanced age does not seem to contraindicate surgery, even in patients with severe preoperative neurological deficits the quality of life can be improved in most cases [10]. For ventrally located spinal meningiomas, the transthoracic approach has been used.…”

Section: Discussionmentioning

confidence: 99%

Posterior approach to ventrally located spinal meningiomas

et al. 2010

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For the resection of anteriorly located meningiomas, various approaches have been used. Posterior approach is less invasive and demanding; however, it has been associated with increased risk of spinal cord injury. We evaluated ten consecutive patients that underwent surgery for spinal meningiomas. All patients were preoperative assessed by neurological examination, computed tomography and magnetic resonance imaging. All tumors were ventrally located and removed via a posterior approach. Transcranial motor-evoked potentials (TcMEPs), somatosensory-evoked potential (SSEP) and free running electromyography (EMG) were monitored intraoperative. Postoperative all patients had regular follow-up examinations. There were four males and six females. The mean age was 68.2 years (range 39-82 years). In nine out of ten cases, the tumor was located in the thoracic spine. A case of a lumbar meningioma was recorded. The most common presenting symptom was motor and sensory deficits and unsteady gait, whereas no patient presented with paraplegia. All meningiomas were operated using a microsurgical technique via a posterior approach. During the operation, free running EMG monitoring prompted a surgical alert in case of irritation, whereas TcMEP and SSEP amplitudes remained unchanged. Histopathology revealed the presence of typical (World Health Organisation grade I) meningiomas. The mean Ki-67/MIB-1 index was 2.75% (range 0.5-7). None of our patients sustained a transient or permanent motor deficit. After a mean follow-up period of 26 months (range 56-16 months), no tumor recurrence and no instability were found. Posterior approach for anteriorly located meningiomas is a safe procedure with the use of intraoperative monitoring, less invasive and well-tolerated especially in older patients. Complete tumor excision can be performed with satisfactory results.

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Section: Discussionmentioning

confidence: 99%

Posterior approach to ventrally located spinal meningiomas

et al. 2010

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“…6 The reports discussing a subset of spinal meningiomas were excluded as well. 11,28,37,46,49 The summary of these studies are tabulated (see Table 5). …”

Section: Literature Reviewmentioning

confidence: 99%

Spinal meningiomas: clinicoradiological factors predicting recurrence and functional outcome

Maiti

Bir

Patra

et al. 2016

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OBJECTIVE Spinal meningiomas are benign tumors with a wide spectrum of clinical and radiological features at presentation. The authors analyzed multiple clinicoradiological factors to predict recurrence and functional outcome in a cohort with a mean follow-up of more than 4 years. The authors also discuss the results of clinical studies regarding spinal meningiomas in the last 15 years. METHODS The authors retrospectively reviewed the clinical and radiological details of patients who underwent surgery for spinal tumors between 2001 and 2015 that were histopathologically confirmed as meningiomas. Demographic parameters, such as age, sex, race, and association with neurofibromatosis Type 2, were considered. Radiological parameters, such as tumor size, signal changes of spinal cord, spinal level, number of levels, location of tumor attachment, shape of tumor, and presence of dural tail/calcification, were noted. These factors were analyzed to predict recurrence and functional outcome. Furthermore, a pooled analysis was performed from 13 reports of spinal meningiomas in the last 15 years. RESULTS A total of 38 patients were included in this study. Male sex and tumors with radiological evidence of a dural tail were associated with an increased risk of recurrence at a mean follow-up of 51.2 months. Ventral or ventrolateral location, large tumors, T2 cord signal changes, and poor preoperative functional status were associated with poor functional outcome at 1-year follow-up. CONCLUSIONS Spine surgeons must be aware of the natural history and risk factors of spinal meningiomas to establish a prognosis for their patients.

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“…Posterior spinal approaches provide for adequate exposure of the dorsal spinal cord and posteriorly situated lesions, with the potential for lateral extension by transpedicular or costotranversectomy approaches for larger lesions or lesions with more ventral extension (50). However, doing so is often at the expense of segmental spinal stability requiring instrumented fusion (28).…”

Section: Surgical Approachesmentioning

confidence: 99%