Spinal meningiomas – Risks and potential of an increasing age at the time of surgery

Schwake, Michael; Adeli, Alborz; Sporns, Peter; Ewelt, Christian; Schmitz, Timo; Sicking, Johanna; Heß, Katharina; Spille, Dorothee Cäcilia; Paulus, Werner; Stummer, Walter; Brokinkel, Benjamin

doi:10.1016/j.jocn.2018.08.030

Cited by 21 publications

(54 citation statements)

References 27 publications

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“…Meningiomas represent the most common primary spinal neoplasm, and they have a predilection for the thoracic spine. [8][9][10] Most tend to represent WHO grade I neoplasms, with low mitotic activity and low risk of recurrence. These tumors also engender a very low annual growth rate, and resection is only considered depending on preoperative symptoms or if the tumor is large enough that it would necessitate intervention to prevent spinal cord compression.…”

Section: Discussionmentioning

confidence: 99%

“…Older age would be an unsurprising risk factor for this outcome in spinal meningiomas, as increasing age has been associated with increased risk of preoperative neurological deficits and postoperative nonneurological complications. 10 It is possible that a larger sample size would be more revealing for predictive factors in this cohort.…”

Section: Operative Details and Patient Dispositionmentioning

confidence: 96%

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Clinical characteristics and long-term outcomes for patients who undergo cytoreductive surgery for thoracic meningiomas: a retrospective analysis

Ampie

Snyder

Dominguez

et al. 2021

Neurosurgical Focus

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OBJECTIVE Primary spinal meningiomas represent a rare indolent neoplasm usually situated in the intradural-extramedullary compartment. They have a predilection for afflicting the thoracic spine and most frequently present with sensory and/or motor symptoms. Resection is the first-line treatment for symptomatic tumors, whereas other clinical factors will determine the need for adjuvant therapy. In this study, the authors aimed to elucidate clinical presentation, functional outcomes, and long-term outcomes in this population in order to better equip clinicians with the tools to counsel their patients. METHODS This is a retrospective analysis of patients treated at the authors’ institution between 1998 and 2018. All patients with thoracic meningiomas who underwent resection and completed at least one follow-up appointment were included. Multiple preoperative clinical variables, hospitalization details, and long-term outcomes were collected for the cohort. RESULTS Forty-six patients who underwent resection for thoracic meningiomas were included. The average age of the cohort was 59 years, and the median follow-up was 53 months. Persistent sensory and motor symptoms were present in 29 patients (63%). Fifteen lesions were ventrally positioned. There were 43 WHO grade I tumors, 2 WHO grade II tumors, and 1 WHO grade III tumor; the grade III tumor was the only case of recurrence. The median length of hospitalization was 4 days. Seventeen patients (37%) were discharged to rehabilitation facilities. Thirty patients (65.2%) experienced resolution or improvement of symptoms, and there were no deaths within 30 days of surgery. Only 1 patient developed painful kyphosis and was managed medically. Ventral tumor position, new postoperative deficits, and length of stay did not correlate with disposition to a facility. Age, ventral position, blood loss, and increasing WHO grade did not correlate with length of stay. CONCLUSIONS Outcomes are overall favorable for patients who undergo resection of thoracic meningiomas. Symptomatic patients often experience improvement, and patients generally do not require significant future operations. Tumors located ventrally, while anatomically challenging, do not necessarily herald a significantly worse prognosis or limit the extent of resection.

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Section: Discussionmentioning

confidence: 99%

Section: Operative Details and Patient Dispositionmentioning

confidence: 96%

Clinical characteristics and long-term outcomes for patients who undergo cytoreductive surgery for thoracic meningiomas: a retrospective analysis

Ampie

Snyder

Dominguez

et al. 2021

Neurosurgical Focus

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“…Spinal meningiomas (SMs) are benign and slow-growing lesions accounting for 25% to 46% of intradural extramedullary lesions [1][2][3]. Most of the affected patients are aged 60 to 80 years old, with a predilection for women over men, with a ratio up to 9:1 [1,[4][5][6][7][8][9][10]. These lesions are generally circumscribed, provoking symptoms when compressing the spinal cord, and the neuroradiological investigations are often delayed until altered sensibility, gait disturbances, or sphincteric dysfunction become manifest [6,11].…”

Section: Introductionmentioning

confidence: 99%

“…These lesions are generally circumscribed, provoking symptoms when compressing the spinal cord, and the neuroradiological investigations are often delayed until altered sensibility, gait disturbances, or sphincteric dysfunction become manifest [6,11]. Despite tumor dimensions and severity of cord compression, most of the patients exhibit an excellent postoperative neurological outcome, notwithstanding the older age [9,12]. Several factors have been associated with a poor outcome, such as psammomatous type of meningioma [4] and WHO grade >1 [13,14], invasion of arachnoid/pia mater [14], Simpson grade resection II and III [13][14][15], ventral attachment [8,13,15,16], calcifications [8,16,17], dural tail and T2 cord signal changes [8], duration of symptoms [13,14], poor preoperative functional status [8,13,14], and sphincteric involvement [13].…”

Section: Introductionmentioning

confidence: 99%

“…Several factors have been associated with a poor outcome, such as psammomatous type of meningioma [4] and WHO grade >1 [13,14], invasion of arachnoid/pia mater [14], Simpson grade resection II and III [13][14][15], ventral attachment [8,13,15,16], calcifications [8,16,17], dural tail and T2 cord signal changes [8], duration of symptoms [13,14], poor preoperative functional status [8,13,14], and sphincteric involvement [13]. Few studies have explored the relations between tumor dimensions, cord compression, and functional outcome, thus reporting contrasting results [4,8,9,14,[18][19][20], as illustrated in Table 1. The aim of this study was to perform a thorough analysis of tumor dimensions in terms of tumor area and volume, cord compression, radiological findings, and their correlations with clinical presentation and outcome.…”

Section: Introductionmentioning

confidence: 99%

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

Baro

Moiraghi

Carlucci

et al. 2021

Cancers

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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.

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Behandlung von Wirbelsäulentumoren bei älteren Patienten

Zausinger¹

2021

Neurochirurgie Bei Älteren Patienten

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Spinal meningiomas – Risks and potential of an increasing age at the time of surgery

Cited by 21 publications

References 27 publications

Clinical characteristics and long-term outcomes for patients who undergo cytoreductive surgery for thoracic meningiomas: a retrospective analysis

Clinical characteristics and long-term outcomes for patients who undergo cytoreductive surgery for thoracic meningiomas: a retrospective analysis

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

Behandlung von Wirbelsäulentumoren bei älteren Patienten

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