Abstract

BackgroundSpinal 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. ObjectiveTo 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. MethodsA large single center retrospective analysis of 166 consecutive spinal meningioma patients during a 29-year period (1989–2018). ResultsFemale 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. ConclusionsThe 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.

Highlights

  • Spinal tumors are classified as either extradural or intradural in relation to the spinal meninges

  • Information about tumor size was only available in 55 cases, with a mean meningioma volume of 2.1 ± 1.2 mL, and a minimum and maximum length of around 10 and 50 mm, respectively

  • We report the surgical outcomes of a retrospective cohort of 166 consecutive patients with spinal meningiomas treated through an open microsurgical approach at our institution during a 29-year period

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Summary

Introduction

Spinal tumors are classified as either extradural or intradural in relation to the spinal meninges. Meningiomas are among the most frequent IDEMs, representing about 12 % of all meningiomas [30] and 25 %–45 % of all intradural spinal tumors [13,46,6]. Meningiomas are often benign, slow-growing tumors with a peak age incidence between 40 and 70 years and a male:female ratio of 1:4 [38]. Their distribution along the spinal axis varies whereby the majority (67–84 %) of spinal meningiomas are located within the thoracic region [2,11,45]. Objective: To evaluate postoperative outcome, defined by mortality, tumor recurrence and modified Rankin Scale in patients with spinal meningiomas. Longer follow-up periods are recom­ mended, since recurrences can occur after 10–15 years

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