Spinal Meningiomas Prognostic Evaluation Score (SPES): predicting the neurological outcomes in spinal meningioma surgery

Abstract

Among many factors leading to a worse functional prognosis in spinal meningioma (SM) surgery, in a previous study, we recognized anterior/anterolateral axial topography, sphincter involvement at first evaluation, surgery performed on a recurrence, and worse preoperative functional status. The purpose of this paper is to evaluate the cumulative weight of these factors on prognosis through a multinomial logistic regression model performed on an original evaluation scale designed by the authors on the ground of the experience of the neurosurgical departments of our University. The original SM database composed of 173 cases was classified in regard to sex, age, symptoms, axial and sagittal location, Simpson grade resection, and functional pre/postoperative status. Fine presurgical and follow-up reevaluations were available. The authors propose a scale (Spinal Meningiomas Prognostic Evaluation Score (SPES)) of preoperative evaluation to assess the surgery-related risk of neurological worsening experienced by the patients included in the present cohort. The authors describe a strong statistical association between the SPES and the follow-up Frankel and McCormick scores (r = - 460 and .441, p .001, both). Through a univariate ANOVA analysis, we disclosed that patients presenting scores 2 and 3 had a significantly higher association to lesser Frankel and McCormick postoperative scores, in respect to patients presenting SPES scores 0-1 (univariate ANOVA, p .008 and .011). Anterior or anterolateral axial location, operating on a recurrence of SM, sphincter involvement, and worse functional grade at onset present, along with the SPES scores are fairly predictive and reliable in respect to the long-term results of patients suffering from SM.

The Clinical and Radiological Outcome of Cervical Spinal Meningioma

“…The most common axial location in our series was ventrolateral (12 patients, 54.5%); dorsolateral location was represented in 4 patients (18.2%). As previously reported by other authors, the ventral/ventrolateral topography is a quite common location for the dural attachment of the spinal meningiomas (38.5-65.2%) 3,9) . The meningothelial type (14 patients, 63.7%) of meningioma was the most common histology subtype in our series, followed by psammomatous in 4 patients (18.2%).…”

“…The most common presenting symptoms were paresthesia (15 patients, 68.2%) in our series and the mean duration of symptoms before presentation was 11.2±20.5 months. Majority of prior reports of spinal meningiomas 3,5,10,15) informed similar predominant symptom and duration. Also, prior studies reported 26.3% to 51% of bladder and sphincter disturbances, but our series showed no significant difference in bladder and sphincter disturbances.…”

Age at Diagnosis and Baseline Myelomalacia Sign Predict Functional Outcome After Spinal Meningioma Surgery

“…The poor functional outcome of those patients in our study having a baseline myelomalacia sign might be explained by the majority having a late stage or advance stage myelomalacia (25). Frati et al (34) developed an interesting score predicting the neurological outcome in a retrospective series investigating 173 spinal meningioma cases. This study identified anterior location, operating on a recurrent SM, sphincter involvement, and worse functional grade at onset as potential predictors of the functional outcome.…”

Management of Extramedullary Intradural Spinal Tumors: The Impact of Clinical Status, Intraoperative Neurophysiological Monitoring and Surgical Approach on Outcomes in a 12-Year Double-Center Experience

“…It is widespread opinion, corroborated by evidence, that clinical status of patients with spinal cord tumors usually benefits from early surgery. The early recognition of signs and symptoms, that allows diagnosis of early-stage disease before spinal cord damage occurs, can reduce the risk of postoperative morbidity and may improve surgical outcome (29)(30)(31). A strong correlation has been suggested between the degree of functional impairment and the extent of damage to the spinal cord or spinal roots: the greater the impairment, the longer the persistence of the lesion, and the more difficult postoperative functional recovery will be, despite radical tumor removal (32)(33)(34)(35).…”