Spinal meningiomas: higher incidence of atypical pathology in symptomatic lumbar lesions

The aim of this study was to assess differences in incidence, demographics, pathology, management, and functional outcomes between lumbar and cervicothoracic spinal meningiomas (SMs).

A retrospective review of patients undergoing resection of SMs at an academic tertiary care hospital between January 2013 and December 2024 was performed after approval from the IRB. Seventy-three consecutive patients who underwent resection of SMs were identified and included for analysis. The patients' electronic medical records were reviewed to collect data on demographics, clinical presentation, radiographic findings, surgical details, pathology reports, and long-term functional outcomes.

A majority of patients were female (84.9%). The median overall age was 65 years and the median age for patients with lumbar meningiomas trended lower (44 years) compared with cervical (66 years) and thoracic (65 years) meningiomas, although this difference was not statistically significant. The most common presenting symptom for lumbar meningiomas was pain (88.9%) followed by weakness (11.1%), with weakness being a more common presenting symptom in the cervical (38.9%) and thoracic (41.3%) spine. WHO grade 2 tumors were present significantly more often in the lumbar spine (55.6%) compared with the cervical (0%) or thoracic (1%) spine (p < 0.001) and were commonly clear cell subtype (44.4%). Patients with lumbar meningioma required significantly more surgeries for the meningioma than those with cervical and thoracic meningiomas (p < 0.001) but were not more likely to require adjuvant medical or radiation therapy. There were no significant differences by region in outcome regarding pain control and neurological function.

Symptomatic SMs of the lumbar spine were more likely to be malignant than those in the cervical or thoracic spine and more likely to require multiple surgeries. Resection of SMs in any location generally resulted in symptom improvement or resolution correlating with current standard of practice.