1
|
de Oliveira MPR, Sandes PHF, de Oliveira Piñeiro GT, de Souza DCR, Nunes GSM, Dos Passos GS. Resection vs. coagulation of dural attachment in patients with spinal meningioma: an updated systematic review and meta-analysis. Acta Neurochir (Wien) 2024; 166:346. [PMID: 39167255 DOI: 10.1007/s00701-024-06235-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Accepted: 08/14/2024] [Indexed: 08/23/2024]
Abstract
BACKGROUND The Simpson grading scale assumes dural resection (grade I) is more effective against recurrence than coagulation (grade II). However, the results of recent studies have raised doubts about this effectiveness in spinal meningiomas. Therefore, we aimed to perform a meta-analysis comparing outcomes between Simpson grades I and II in spinal meningiomas. METHODS According to the PRISMA statement, we systematically searched PubMed, EMBASE, and Web of Science for studies involving patients with spinal meningiomas who underwent Simpson grades I, II, III, or IV. Outcomes were radiological tumor recurrence, postoperative neurological deficits, and procedure-related complications. RESULTS We included 54 studies with a total of 3334 patients. Simpson grades I, II, III, and IV were performed in 674 (20%), 2205 (66%), 254 (8%), and 201 (6%) patients, respectively. The follow-up ranged from 9 to 192 months, and 95.4% of all tumors were WHO grade 1. There was no difference in radiological tumor recurrence (OR 0.80, 95% CI: 0.46-1.36, P = 0.41; I2 = 0%), postoperative neurological deficits (OR 0.74, 95% CI: 0.32-1.75, P = 0.50; I2 = 0%) or procedure-related complications (OR 2.22, 95% CI: 0.80-6.13, P = 0.12; I2 = 3%) between Simpson grades I and II. Furthermore, no significant difference in postoperative neurological deficits or procedure-related complications was detected when comparing all Simpson's to each other. However, radiological tumor recurrences in Simpson I and II were significantly lower than in III and IV, with Simpson III outperforming IV (OR 0.19, 95% CI: 0.09-0.40, P < 0.01; I2 = 0%). CONCLUSION Simpson grade I is not more effective than grade II in any outcome, although both are superior to III and IV in tumor recurrence. Our results might suggest that dural coagulation is preferable over resection when the latter carries a higher risk of complications.
Collapse
|
2
|
Kiyoshi T, Yoshihiro M, Kazuya Y, Kazu K, Hirokazu S, Kenichi K, Yasuharu N. Dural reconstruction following resection of ventral and lateral spinal cord meningiomas: Fenestrated Durotomy with Oversized Graft technique. J Clin Neurosci 2023; 116:120-124. [PMID: 37696149 DOI: 10.1016/j.jocn.2023.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 09/03/2023] [Accepted: 09/05/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Meningiomas, although benign, often require complete resection due to their tendency for recurrence. However, dural reconstruction poses significant challenges, especially in the case of ventral meningiomas. While some reports have highlighted the usefulness of dural reconstruction using an artificial dura mater, no studies have yet confirmed dural canal enlargement through MRI post-surgically. This study aimed to assess the effectiveness of the Fenestrated Durotomy with Oversized Graft (FDOG) technique in cases of meningiomas and other intradural extramedullary tumors and evaluated dural canal dilation through MRI after using an artificial dura mater. METHODS This retrospective case series included 8 patients who underwent combined resection of intradural extramedullary tumors and dural repair using the FDOG technique. An artificial dura mater larger than that resected was inserted into the dural defect resulting from complete tumor resection on the ventral or lateral side of the spinal cord. The new dura mater was secured with a single dorsal suture. The dural incision was closed using watertight sutures following standard procedure. Measurement of the extent of dural canal enlargement was achieved via pre- and postoperative MRI scans. RESULTS None of the patients required additional treatments or lumbar drainage. All achieved independent ambulation without complications, and imaging tests indicated satisfactory dural expansion without signs of cerebrospinal fluid leakage. CONCLUSIONS The proposed method for dural repair in cases involving large dural defects on the ventral or lateral side of the spinal cord was shown to be a straightforward and effective approach with minimal postoperative complications.
Collapse
Affiliation(s)
- Tarukado Kiyoshi
- Department of Orthopaedic Surgery, Kyushu University, Fukuoka, Japan.
| | - Matsumoto Yoshihiro
- Department of Orthopaedic Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yokota Kazuya
- Department of Orthopaedic Surgery, Kyushu University, Fukuoka, Japan
| | - Kobayakawa Kazu
- Department of Orthopaedic Surgery, Kyushu University, Fukuoka, Japan
| | - Saiwai Hirokazu
- Department of Orthopaedic Surgery, Kyushu University, Fukuoka, Japan
| | - Kawaguchi Kenichi
- Department of Orthopaedic Surgery, Kyushu University, Fukuoka, Japan
| | | |
Collapse
|
3
|
Current Knowledge on Spinal Meningiomas-Surgical Treatment, Complications, and Outcomes: A Systematic Review and Meta-Analysis (Part 2). Cancers (Basel) 2022; 14:cancers14246221. [PMID: 36551706 PMCID: PMC9777510 DOI: 10.3390/cancers14246221] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 12/12/2022] [Accepted: 12/14/2022] [Indexed: 12/23/2022] Open
Abstract
Background: Most of the knowledge on spinal meningiomas is extrapolated from their intracranial counterparts, even though they are considered separate entities. This review aimed to systematically summarize studies covering different aspects of spinal meningiomas and their management. Methods: Databases were searched for all studies concerning spinal meningiomas dating from 2000 and onwards. When possible, a meta-analysis was performed. Results: Neurological outcomes of surgery were consistently favorable across studies, with a complication rate of 7.9% and 78.9% of the patients demonstrating good postoperative neurological function (McCormick score 1−2). The most relevant predictors of unfavorable outcomes were poor preoperative status, longer time from diagnosis to surgery, and surgery of recurrent tumors. The recurrence rate after surgery was estimated at 6%. Meta-analysis and/or survival analysis revealed that higher WHO grade (p < 0.001), higher Simpson grade (p < 0.001), ventral tumor location (p = 0.02), and male sex (p = 0.014) were all associated with higher odds of recurrence. However, the meta-analysis did not show any difference between Simpson grade 1 and grade 2 with respect to the odds of recurrence (p = 0.94). Surgery provided immediate and durable health-related quality-of-life improvement, as well as a high frequency of return to work. Conclusion: Spinal meningioma surgery is a relatively safe procedure with a low risk of tumor recurrence and high likelihood of favorable postoperative outcomes.
Collapse
|
4
|
Hijikata Y, Ueda S, Yasuhara T, Umebayashi D, Endo T, Takami T, Mizuno M, Hida K, Hoshimaru M. Description of the Diversity in Surgical Indication and Surgical Strategies for Primary Spinal Cord Tumors: A Nationwide Survey by the Neurospinal Society of Japan. Neurospine 2022; 19:1122-1129. [PMID: 36597646 PMCID: PMC9816577 DOI: 10.14245/ns.2244686.343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/14/2022] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To assess the current management of primary spinal cord tumors (PSCTs) and determine whether and to what extent there are differences in surgical strategies for PSCTs. METHODS The Neurospinal Society of Japan conducted a survey between April 1 and 30, 2021. Certified spine surgeons were requested for information on the frequency of surgeries in 2020 and the surgical strategies adopted for each PSCTs. The following tumor histologies were focused: schwannoma, meningioma, and cauda equina tumor as extramedullary tumors; and ependymoma, hemangioblastoma, astrocytoma, and cavernoma as intramedullary tumors. The participants were divided according to their response as follows: experts, who had experienced ≥ 100 surgeries for PSCTs, and nonexperts. RESULTS Among 308 participants (63%), 35 (11%) were experts. The total number of PSCTs in 2020 was 802 of which 564 tumors were extramedullary and 223 were intramedullary. Schwannoma accounted for 53% of the extramedullary tumors, and ependymoma accounted for 39% of the intramedullary tumors. Surgical strategies significantly differed among both the experts and nonexperts groups. Some discrepancies in the adopted surgical strategies were observed between groups. Some of the nonexperts, and none of the experts, ruled out surgery for schwannomas (Eden type 4), astrocytomas, or cavernomas. Five nonexperts (2.2%), and none of the experts, resected the entire dura for meningiomas. CONCLUSION A nationwide survey revealed that a sufficient consensus did not exist regarding surgical strategies for PSCTs. A disease-specific registry for PSCTs is necessary in academic societies.
Collapse
Affiliation(s)
- Yasukazu Hijikata
- Spine and Low Back Pain Center, Kitasuma Hospital, Kobe, Japan,Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan,Corresponding Author Yasukazu Hijikata Spine and Low Back Pain Center, Kitasuma Hospital, 1-1, 1 Cho-me, Higashishirakawadai, Sma-ku, Kobe 654-0102, Japan
| | - Shigeo Ueda
- Shin-Aikai Spine Center, Katano Hospital, Katano, Japan
| | - Takao Yasuhara
- Department of Neurological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Daisuke Umebayashi
- Department of Neurosurgery, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Toshiki Endo
- Department of Neurosurgery, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Toshihiro Takami
- Department of Neurosurgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Masaki Mizuno
- Department of Minimum-Invasive Neurospinal Surgery, Mie University Graduate School of Medicine, Tsu, Japan
| | - Kazutoshi Hida
- Department of Neurosurgery, Sapporo Azabu Neurosurgical Hospital, Sapporo, Japan
| | | |
Collapse
|
5
|
Spirollari E, Vazquez S, Das A, Wang R, Ampie L, Carpenter AB, Zeller S, Naftchi AF, Beaudreault C, Ming T, Thaker A, Vaserman G, Feldstein E, Dominguez JF, Kazim SF, Al-Mufti F, Houten JK, Kinon MD. Characteristics of Patients Selected for Surgical Treatment of Spinal Meningioma. World Neurosurg 2022; 165:e680-e688. [PMID: 35779754 DOI: 10.1016/j.wneu.2022.06.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 06/23/2022] [Accepted: 06/23/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Spinal meningiomas are benign extra-axial tumors that can present with neurological deficits. Treatment partly depends on the degree of disability as there is no agreed-upon patient selection algorithm at present. We aimed to elucidate general patient selection patterns in patients undergoing surgery for spinal meningioma. METHODS Data for patients with spinal tumors admitted between 2016 and 2019 were extracted from the U.S. Nationwide Inpatient Sample. We identified patients with a primary diagnosis of spinal meningioma (using International Classification of Disease, 10th revision codes) and divided them into surgical and nonsurgical treatment groups. Patient characteristics were evaluated for intergroup differences. RESULTS Of 6395 patients with spinal meningioma, 5845 (91.4%) underwent surgery. Advanced age, nonwhite race, obesity, diabetes mellitus, chronic renal failure, and anticoagulant/antiplatelet use were less prevalent in the surgical group (all P < 0.001). The only positive predictor of surgical treatment was elective admission status (odds ratio, 3.166; P < 0.001); negative predictors were low income, Medicaid insurance, anxiety, obesity, and plegia. Patients with bowel-bladder dysfunction, plegia, or radiculopathy were less likely to undergo surgical treatment. The surgery group was less likely to experience certain complications (deep vein thrombosis, P < 0.001; pulmonary embolism, P = 0.002). Increased total hospital charges were associated with nonwhite race, diabetes, depression, obesity, myelopathy, plegia, and surgery. CONCLUSIONS Patients treated surgically had a decreased incidence of complications, comorbidities, and Medicaid payer status. A pattern of increased utilization of health care resources and spending was also observed in the surgery group. The results indicate a potentially underserved population of patients with spinal meningioma.
Collapse
Affiliation(s)
| | - Sima Vazquez
- New York Medical College, Valhalla, New York, USA
| | - Ankita Das
- New York Medical College, Valhalla, New York, USA
| | - Richard Wang
- New York Medical College, Valhalla, New York, USA
| | - Leonel Ampie
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Austin B Carpenter
- Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, New York, USA
| | - Sabrina Zeller
- Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, New York, USA
| | | | | | - Tiffany Ming
- New York Medical College, Valhalla, New York, USA
| | - Akash Thaker
- New York Medical College, Valhalla, New York, USA
| | | | - Eric Feldstein
- Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, New York, USA
| | - Jose F Dominguez
- Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, New York, USA.
| | - Syed Faraz Kazim
- Department of Neurosurgery, University of New Mexico Hospital, Albuquerque, New Mexico, USA
| | - Fawaz Al-Mufti
- Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, New York, USA
| | - John K Houten
- Department of Neurosurgery, Maimonides Medical Center, Northwell School of Medicine, Brooklyn, New York, USA
| | - Merritt D Kinon
- Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, New York, USA
| |
Collapse
|
6
|
Wang X, Wang J, Wang L, Lin Y, Yang M, Chen X, Teng L, Guo H, Chen X. Surgical Resection of Dorsal Spinal Meningiomas with the Inner Dura Layer - an Improved Preservation Technique of Spinal Dura in 40 Cases. World Neurosurg 2022; 160:e250-e255. [PMID: 34999010 DOI: 10.1016/j.wneu.2021.12.118] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/30/2021] [Accepted: 12/31/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Spinal meningiomas are the common benign tumors in intradural extramedullary spinal tumors. Simpson grade I resection is recommended to avoid tumor recurrence. However, the dura reconstruction increases a risk of cerebrospinal fluid leakage after this surgical resection. To address this concern, the inner dura layer resection and the long-term surgical outcomes of this technique were designed and examined after total tumor resection to preserve the outer dura layer. METHODS This study included 40 spinal meningioma patients undergoing the outer dura layer resection between 2002 and 2019. Clinical characteristics, radiological features, pre- and post-operative functional states, tumor recurrence and perioperative complications were described and evaluated. RESULTS A total of 40 spinal meningioma cases with the median age of 63 years (36-81 years) are enrolled in this study. The median postoperative follow-up period of all 40 cases is 96 months (34-193 months). About 82.5% of cases are located in the thoracic spine, while 16.5% of cases are located in the cervical spine. Of the symptomatic cases, 87.5% of cases follow with satisfactory outcomes, 12.5% of cases follow with unexpected outcomes. The local spinal meningioma recurrence rate was 2.5% (1 of 40 cases). None postoperative cerebrospinal fluid leak occurs in all 40 spinal meningioma cases. CONCLUSION A long-term of postoperative follow-up indicated this modified spinal dura preservation technique causes the good neurological improvement with rare recurrence. Therefore, we recommend this improved technique may be an alternative surgical option for total resection of spinal meningiomas with favorable prognosis.
Collapse
Affiliation(s)
- Xiaoxiong Wang
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China; Institute of Brain Science, Harbin Medical University, Harbin, People's Republic of China; Institute of Neuroscience, Sino-Russian Medical Research Center, Harbin Medical University, Harbin, People's Republic of China
| | - Jiabin Wang
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China; Institute of Brain Science, Harbin Medical University, Harbin, People's Republic of China; Institute of Neuroscience, Sino-Russian Medical Research Center, Harbin Medical University, Harbin, People's Republic of China
| | - Liankun Wang
- Department of Neurology, Heilongjiang Province Hospital, Harbin, People's Republic of China
| | - Yongdong Lin
- Department of Neurosurgery, Traditional Chinese Medicine Hospital, Jixi, People's Republic of China
| | - Mingchun Yang
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China; Institute of Brain Science, Harbin Medical University, Harbin, People's Republic of China; Institute of Neuroscience, Sino-Russian Medical Research Center, Harbin Medical University, Harbin, People's Republic of China
| | - Xiaoli Chen
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Lei Teng
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China; Institute of Brain Science, Harbin Medical University, Harbin, People's Republic of China; Institute of Neuroscience, Sino-Russian Medical Research Center, Harbin Medical University, Harbin, People's Republic of China
| | - Hua Guo
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China
| | - Xiaofeng Chen
- Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China; Institute of Brain Science, Harbin Medical University, Harbin, People's Republic of China; Institute of Neuroscience, Sino-Russian Medical Research Center, Harbin Medical University, Harbin, People's Republic of China.
| |
Collapse
|