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Spinal meningiomas: Treatment outcome and long-term follow-up
L E Kwee1, B S Harhangi2, G A Ponne2
1Department of Neurosurgery, Noordwest Ziekenhuisgroep, Alkmaar, the Netherlands.
Background:
Spinal intradural tumors can be classified as intradural extramedullary or intramedullary tumors. Spinal meningiomas are among the most frequent intradural, extramedullary tumors (IDEMs), representing 12 % of all meningiomas and 25-45 % of all intradural spinal tumors.
Objective:
To evaluate postoperative outcome, defined by mortality, tumor recurrence and modified Rankin Scale in patients with spinal meningiomas. Furthermore, to identify factors related to these outcome measures and define possible prognosticators.
Methods:
A large single center retrospective analysis of 166 consecutive spinal meningioma patients during a 29-year period (1989-2018).
Results:
Female to male ratio was 5.15 to 1. Of all 166 resected tumors, 159 were WHO grade I and seven were WHO grade II. Histopathologically, the psammomatous type was most common (42.8 %). The thoracic region was the most frequent location (71.1 %), followed by cervical and lumbar locations. A complete resection (Simpson I-III) was achieved in 88.7 %. In 12 cases (7.2 %) recurrences of a spinal meningioma occurred after an interval of 0.70-13.78 years. Postoperative complications consisted of CSF leakage and wound healing problems. Three patients died of direct postoperative complications (1.8 %), nine patients died in follow-up due to unrelated causes. Post-operative complications were related to the overall outcome (p = 0.029). Clinical outcome showed improvement in 117 patients out of 148 (79.1 %) according to modified Rankin Scale; 24 patients remained stable and 7 patients deteriorated. Patients with pre-existing bladder/bowel problems and incomplete resections had higher chance of recurrences. Younger patients also had a higher recurrence rate. Follow-up ranged from 0 to 23 years, median of 0.77 years, most were discontinued after 2 years.
Conclusions:
The primary treatment of spinal meningiomas remains surgery. Complete resection of spinal meningiomas is achieved in most of the cases, however preserving and improving neurological status has priority over complete tumor resection. Morbidity and mortality is relatively low. Longer follow-up periods are recommended, since recurrences can occur after 10-15 years.
Insights
Spinal meningiomas are common intradural tumors. Surgery offers good outcomes, but longer follow-up is needed due to potential late recurrences, especially in younger patients.
Area of Science:
- Neurosurgery
- Oncology
- Spinal Surgery
Background:
- Spinal meningiomas are frequent intradural, extramedullary tumors (IDEMs).
- They represent 12% of all meningiomas and 25-45% of intradural spinal tumors.
Purpose of the Study:
- Evaluate postoperative outcomes in spinal meningioma patients.
- Identify factors influencing mortality, recurrence, and functional status (modified Rankin Scale).
- Define potential prognosticators for spinal meningioma management.
Main Methods:
- Retrospective analysis of 166 spinal meningioma patients over 29 years (1989-2018).
- Data collected on tumor characteristics, surgical resection extent, postoperative complications, recurrence, and functional outcomes.
Main Results:
- Complete resection (Simpson I-III) achieved in 88.7% of cases.
- Recurrence occurred in 7.2% of patients, with higher rates in younger patients and those with incomplete resection.
- 79.1% of patients showed improved functional status (mRS); postoperative complications impacted overall outcome.
Conclusions:
- Surgery is the primary treatment for spinal meningiomas, prioritizing neurological preservation.
- Morbidity and mortality are low, but longer follow-up is crucial for detecting late recurrences.
- Prognostic factors include pre-existing bladder/bowel issues and resection completeness.
