Spinal Meningiomas: Influence of Cord Compression and Radiological Features on Preoperative Functional Status and Outcome

Abstract

Background: Radiological parameters predicting the postoperative neurological outcome after resection of a spinal meningioma (SM) are poorly studied, with controversial results. Methods: Observational multicenter cohort (2011–2018) of adult patients undergoing surgery for resection of SM. Tumor-canal volume ratio (TCR), the areas related to the cord and tumor occupancy at maximum compression, the presence of dural tail, calcifications, signs of myelopathy, and postoperative cord expansion were compared with the modified McCormick scale (mMCS) preoperative and at follow-up. Results: In the cohort (n = 90 patients), cord and tumor occupancy as well as cord compression and tumor volume showed a correlation with preoperative mMCS (p < 0.05, R −0.23; p < 0.001, R 0.35; p < 0.005, R −0.29; p < 0.001, R 0.42). Cord occupancy had a strong correlation with cord compression (p < 0.001, R 0.72). Tumor occupancy and TCR were correlated with relative outcome at follow-up (p < 0.005 R 0.3; p < 0.005 R 0.29). No correlation was found between cord re-expansion and clinical outcome at follow-up. Finally, a correlation was shown between preoperative signs of cord myelopathy and mMCS (p < 0.05 R 0.21) at follow-up. Conclusions: Larger tumors showed lower preoperative functional status and a worse clinical outcome. Moreover, preoperative T2 cord signal changes are correlated with a poorer outcome.

Current Knowledge on Spinal Meningiomas Epidemiology, Tumor Characteristics and Non-Surgical Treatment Options: A Systematic Review and Pooled Analysis (Part 1)

“…Three studies only including adults (>18 years) reported 28 cases among 3063 patients (0.9%) [ 4 , 55 , 56 ]. The lower percentage in these studies may indicate that a significant number of these patients are diagnosed before reaching adulthood.…”

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

“…Few studies have explored the relationship between tumor dimensions, cord compression, and functional outcome and/or preoperative neurological impairment, and results have been conflicting [ 6 , 10 , 43 , 44 ]. In our series, we found a significant correlation between preoperative spinal cord compression (measured as TCR) and functional impairment.…”

“…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 ].…”

“…In advanced disease, there can be dissociated long tract signs, including Brown-Sequard syndrome [ 2 ]. For many patients, the diagnosis is not confirmed until neurological deficits or gait disturbances become apparent [ 5 , 6 ].…”