Characteristics and surgical management of spinal meningiomas in the Himalayan region

Abstract

Background: Spinal meningiomas, originating from arachnoid cap cells, primarily manifest in the intradural extramedullary region, commonly favouring the thoracic area, albeit occurrences in the cervical, lumbar, and exceptionally rare sacral regions have been noted. Among tumours in this location, meningiomas, neurofibromas, and schwannomas prevail. MRI serves as the preferred imaging modality due to its ability to often reveal the distinctive dural origin of meningiomas. Microdissection and resection stand as the established gold standard for treating spinal meningiomas. Materials and methods: This study, conducted at the Sheri-Kashmir Institute of Medical Sciences Soura Srinagar in Jammu and Kashmir, India, spanned approximately 10 years from August 2009 to July 2017 retrospectively and August 2017 to July 2019 prospectively. It encompassed patients diagnosed with spinal meningiomas, evaluated through comprehensive history-taking, clinical examinations, biochemical assessments, and radiological studies. Surgical interventions predominantly involved laminectomy, aiming for gross total or subtotal tumour resection using a posterior approach. Postoperative complications, such as CSF leaks and wound infections, were monitored, and the duration of hospitalization was recorded from the surgery date to discharge. Results: The results showed a mean patient age of 44 years, with the youngest being 16 years old and the eldest 70 years old. Most patients (40.90%) fell within the 41-50 age group, with 22.72% in the 51-60 age bracket. Among the 22 patients, females comprised 68.18%, resulting in a female-to-male ratio of 2.1:1. The most prevalent symptoms were pain (77%) and weakness (63%), followed by bladder dysfunction (27%). Tumors were primarily located in the thoracic region (68%), with other occurrences in the cervicothoracic (18%), thoracolumbar (9%), and cervical (4.54%) areas. Posterior surgical approaches were utilized in 91% of cases, with the remaining 9% employing an anterior approach. Tumour sizes varied, with 22.72% smaller than 2 cm and 77.27% larger, having a mean greatest diameter of 2.9 cm. Postoperative complications were observed in 9.09% of patients, with CSF leaks and wound infections being the major concerns, while 91% experienced no complications. Conclusions: In conclusion, this study illustrates spinal meningiomas as slow-growing tumors with a subtle onset, typically appearing in the 4th to 5th decade, and exhibiting a female predominance with a 2:1 ratio. Pain emerges as the most prevalent presenting symptom. Surgery stands as the primary treatment, albeit accompanied by potential postoperative complications such as wound infections, CSF leaks, or bowel and bladder dysfunctions. Adjuvant radiotherapy might be considered for recurrent or advanced disease to offer palliative relief.