Factors Leading to a Poor Functional Outcome in Spinal Meningioma Surgery: Clinical and Surgical Remarks on 173 Cases

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Introduction Spinal meningiomas are common spinal tumors in most cases benign and with a good surgical prognosis. However, specific location, infiltration of spinal cord, vascular encasement or spinal root involvement can bring to a less favorable prognosis. Aim of this work is to systematically the influence of this factors in the neurological outcomes of our patients. Matherial and Methods 224 consecutive patients with spinal meningiomas treated from 1976 to 2013 in our institution were analyzed; among these 51 were excluded for incomplete clinical data or follow up. The remaining 173 cases were classified regarding to: sex, age, symptoms, axial location, Simpson Grade resection, Functional pre/postoperative status. Results Most recurring onset symptoms were pain (32,9%) and motor deficit (31,8%); Thoracic spine was the most severely affected (69,8%). The functional improvement on the follow up was observed in 86,7% of cases, 6,4% of patients resulted stable and 6,9% worsened; a low functional grade before surgery was connected to a lesser improvement after. Anterolateral meningiomas were the most represented (42,2%); a gross total resection (Simpson Grade I and II) was conducted in 98,8% and a macroscopically complete removal without dural resection or coagulation (Simpson III) was performed in 1,2%. 98,3% of meningiomas were classified as Grade I WHO. Recurrence rate was of 2,3% and 7 cases presented complications (4 of 7 required surgical procedure). Conclusions We can adfirm that negative prognostic factors in our study were: anterior or antero-lateral axial topography, long-lasting symptoms before diagnosis, WHO Grade > I, Simpson Grade resection II and III, sphincter involvement and worse functional grade at onset.