Spinal Meningiomas: Review of 174 Operated Cases

Abstract

The long-term results obtained in a series of 174 patients operated on for spinal meningiomas are critically analyzed. This series was similar to those of other authors with regard to age, sex, location of the tumors, and clinical presentation. Before surgery, about 70% of the patients were included in Groups I and II (mild neurological impairment), and about 30% of the patients were classified in Groups III and IV (significant to severe neurological impairment, up to paraplegia). Complete tumor removal was achieved in 96.5% of the patients, and surgical mortality was about 1%. Microsurgical technique, which was adopted in the last 29 cases, proved to be very effective in reducing undue damage to the spinal cord and in minimizing the postoperative neurological deficits. Of the 174 patients who underwent surgery, 156 underwent late follow-up study for an average of 15 years (2 patients died in the immediate postoperative period, and 16 patients were lost to follow-up). Twenty-nine patients died of causes unrelated to the spinal meningioma; of the remaining 126 patients, 92% were categorized in Groups I and II, and only 8% in Groups III and IV. The rate of recurrence was 6% (9 patients) among the 150 patients who had complete tumor removal, and the rate of regrowth was 17% (1 patient with anaplastic meningioma) among the 6 patients treated by subtotal removal. The early diagnosis of the disease and the use of microsurgical technique appeared as the most relevant factors for further improvement of the surgical results.

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

“…Twenty-eight of thirty meningiomas were in the thoracic region, and the remaining two were in the cervical region. Solero et al [13] published a report of four meningiomas of the lumbar region, and found the frequency in men and women was equal.…”

“…In one series, lumbosacral meningiomas represented only 2.3% of cases among 705 spinal meningiomas [4]. In two other series meningiomas in patients 70 years or older represented a maximum of 10% of all spinal meningiomas [10,13]. Morandi et al [8] has published the only clinical series of elderly patients with meningioma.…”

“…Alternatively, a wide dural excision and simple duraplasty can be performed. The recurrence rate associated with subtotal resection is significantly higher than that associated with complete resection [6,13]. In the present case, we selected a less invasive technique to minimize surgical morbidity in this elderly woman.…”

“…Intradural meningiomas are almost always adherent to the dura [1,2,5,6,13]. The standard practice is to perform bipolar diathermy to destroy any remaining tumor cells.…”

“…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].…”