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Functional Outcome after Spinal Meningioma Surgery
Vincent Jecko1, Marie-Pierre Loit2,3, Deborah Houston4
1Department of Neurosurgery, Pellegrin Hospital, Bordeaux, France.
Study Design:
A multicenter cross-sectional analytical retrospective study.
Purpose:
To assess functional outcome (FO) after a spinal meningioma (SM) surgery.
Overview Of Literature:
All studies report functional improvement after SM removal.
Methods:
We performed an analytical retrospective cohort study at five different institutions. All patients with a diagnosis of SM were included in this study, including those with recurrent tumors. Meningiomas of the foramen magnum were excluded. Useful histopathological characteristics were separately extracted. Surgical resection was evaluated according to the Simpson grading scale. Patient outcomes and clinical states were assessed with the help of their medical records using four different scales: the modified Ranawat score, the Nurick scale, the Prolo score, the Frankel grade, and the Eastern Cooperative Oncology Group-World Health Organization- Zubrod score.
Results:
Between 1991 and 2018, 417 patients were identified, of which 85.8% were female. The median age at surgery was 67.2 years (interquartile range [IQR], 56.7-76.5). The lesion was located in the thoracic region in 77.9% of the patients, cervical region in 16.8%, and lumbar region in 4.1%. Surgical resection was complete in 95.5% of the cases. Only 0.96% of the patients died within the first postoperative month. Neurological status, which improved in 76.9% of the patients, was unchanged in 17.5% and even worsened in 4.4%. Functional status was assessed using the Ranawat score and Nurick scale, with scores of 1 (IQR, 0-2) (i.e., hyperreflexia and asymptomatic; mean, 1.3±1.3) and 1 (IQR, 0-2) (i.e., signs of spinal cord disease, but no difficulty in walking; mean, 1.2±1.4), respectively. Approximately 10.1% of the patients were not ambulant at the last neurosurgical follow-up visit. Older age at surgery was not significantly associated with a chair-bound status (p =0.427).
Conclusions:
This large series confirms the favorable FO after spinal meningioma surgery even in the case of seriously impaired preoperative status. A validated scale is needed to assess the factors predicting a worsening of the functional status and guide the management of patients.
Insights
Spinal meningioma surgery generally leads to favorable functional outcomes, even for patients with severe preoperative deficits. Further research is needed to identify factors predicting functional decline and guide patient management.
Area of Science:
- Neurosurgery
- Oncology
- Orthopedics
Background:
- Spinal meningiomas are tumors that can cause significant neurological deficits.
- Previous studies indicate functional improvement following surgical resection of spinal meningiomas.
Purpose of the Study:
- To evaluate the functional outcome (FO) in patients undergoing surgery for spinal meningioma (SM).
Main Methods:
- A multicenter, retrospective, analytical cohort study included 417 patients diagnosed with spinal meningioma between 1991 and 2018.
- Surgical resection was graded using the Simpson scale, and patient outcomes were assessed using multiple validated scales (Ranawat, Nurick, Prolo, Frankel, ECOG-WHO-Zubrod).
Main Results:
- The majority of patients (85.8%) were female, with a median age of 67.2 years.
- Complete surgical resection was achieved in 95.5% of cases, with a low mortality rate (0.96%).
- Neurological status improved in 76.9% of patients, while 17.5% remained unchanged and 4.4% worsened. 10.1% were not ambulant at follow-up.
Conclusions:
- Spinal meningioma surgery is associated with favorable functional outcomes, even in patients with significant preoperative impairment.
- A validated scale is required to predict worsening functional status and optimize patient management strategies.
