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Garufi G, Scalia G, Ricciardo G, Umana GE, Conti A, Cardali SM. Spinal Intramedullary Meningiomas: A Systematic Review with a Case Illustration. World Neurosurg 2024; 187:11-18. [PMID: 38548054 DOI: 10.1016/j.wneu.2024.03.124] [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: 01/22/2024] [Revised: 03/20/2024] [Accepted: 03/21/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND Intramedullary meningiomas are an exceptionally rare subtype of spinal tumors, accounting for only 5% of primary spinal neoplasms. Given their scarcity and unique characteristics, understanding optimal management approaches is crucial for improved clinical decision-making. This systematic review aims to consolidate existing literature and present a detailed case illustration to enhance understanding of this uncommon spinal tumor entity. METHODS A systematic search adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted. Eligible studies included case reports, case series, cohort studies, reviews, and meta-analyses. Data extraction and synthesis focused on demographic characteristics, tumor location, clinical presentation, imaging findings, surgical interventions, histopathological features, and outcomes. RESULTS A total of 15 high-quality scientific articles were included in the systematic review, providing insights into various aspects of intramedullary meningiomas. Demographic analysis revealed a broad age distribution with an equal gender distribution among affected patients. Common clinical presentations included difficulty walking, sensory disturbances, spastic paraparesis, and urinary incontinence. Neuroimaging findings demonstrated heterogeneous signal intensity variations on T1- and T2-weighted images, with variable enhancement patterns on gadolinium-enhanced images. Surgical interventions, predominantly total resection, resulted in favorable postoperative outcomes in most cases. CONCLUSIONS Intramedullary meningiomas pose diagnostic and therapeutic challenges due to their rarity and unique characteristics. Tailored surgical approaches, incorporating techniques such as intraoperative neurophysiological monitoring and fluorescence-aided resection, are crucial for minimizing neurological deficits and optimizing patient outcomes. Despite their infrequency, recognizing intramedullary meningiomas in the differential diagnosis of spinal tumors is essential for prompt diagnosis and timely intervention, ultimately improving patient prognosis.
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Affiliation(s)
- Giada Garufi
- Department of Neurosurgery, Azienda Ospedaliera Papardo, University of Messina, Messina, Italy; Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.
| | - Gianluca Scalia
- Neurosurgery Unit, Department of Head and Neck Surgery, Garibaldi Hospital, Catania, Italy
| | - Giuseppe Ricciardo
- Department of Neurosurgery, Azienda Ospedaliera Papardo, University of Messina, Messina, Italy
| | - Giuseppe Emmanuele Umana
- Department of Neurosurgery, Trauma Center, Gamma Knife Center, Cannizzaro Hospital, Catania, Italy
| | - Alfredo Conti
- Department of Neurosurgery, IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy; Dipartimento di Scienze Biomediche e Neuromotorie. (DIBINEM), Alma Mater Studiorum Università di Bologna, Bologna, Italy
| | - Salvatore Massimiliano Cardali
- Department of Neurosurgery, Azienda Ospedaliera Papardo, University of Messina, Messina, Italy; Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Unit of Neurosurgery, University of Messina, Messina, Italy
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Dang DD, Mugge LA, Awan OK, Gong AD, Fanous AA. Spinal Meningiomas: A Comprehensive Review and Update on Advancements in Molecular Characterization, Diagnostics, Surgical Approach and Technology, and Alternative Therapies. Cancers (Basel) 2024; 16:1426. [PMID: 38611105 PMCID: PMC11011121 DOI: 10.3390/cancers16071426] [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: 02/04/2024] [Revised: 03/27/2024] [Accepted: 04/01/2024] [Indexed: 04/14/2024] Open
Abstract
Spinal meningiomas are the most common intradural, extramedullary tumor in adults, yet the least common entity when accounting for all meningiomas spanning the neuraxis. While traditionally considered a benign recapitulation of their intracranial counterpart, a paucity of knowledge exists regarding the differences between meningiomas arising from these two anatomic compartments in terms of histopathologic subtypes, molecular tumor biology, surgical principles, long-term functional outcomes, and recurrence rates. To date, advancements at the bench have largely been made for intracranial meningiomas, including the discovery of novel gene targets, DNA methylation profiles, integrated diagnoses, and alternative systemic therapies, with few exceptions reserved for spinal pathology. Likewise, evolving clinical research offers significant updates to our understanding of guiding surgical principles, intraoperative technology, and perioperative patient management for intracranial meningiomas. Nonetheless, spinal meningiomas are predominantly relegated to studies considering non-specific intradural extramedullary spinal tumors of all histopathologic types. The aim of this review is to comprehensively report updates in both basic science and clinical research regarding intraspinal meningiomas and to provide illustrative case examples thereof, thereby lending a better understanding of this heterogenous class of central nervous system tumors.
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Affiliation(s)
- Danielle D. Dang
- Department of Neurosurgery, Inova Fairfax Medical Campus, Falls Church, VA 22042, USA; (D.D.D.); (L.A.M.); (O.K.A.); (A.D.G.)
| | - Luke A. Mugge
- Department of Neurosurgery, Inova Fairfax Medical Campus, Falls Church, VA 22042, USA; (D.D.D.); (L.A.M.); (O.K.A.); (A.D.G.)
| | - Omar K. Awan
- Department of Neurosurgery, Inova Fairfax Medical Campus, Falls Church, VA 22042, USA; (D.D.D.); (L.A.M.); (O.K.A.); (A.D.G.)
| | - Andrew D. Gong
- Department of Neurosurgery, Inova Fairfax Medical Campus, Falls Church, VA 22042, USA; (D.D.D.); (L.A.M.); (O.K.A.); (A.D.G.)
| | - Andrew A. Fanous
- Department of Neurosurgery, Inova Alexandria Hospital, Alexandria, VA 22304, USA
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3
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Serratrice N, Lameche I, Attieh C, Chalah MA, Faddoul J, Tarabay B, Bou-Nassif R, Ali Y, Mattar JG, Nataf F, Ayache SS, Abi Lahoud GN. Spinal meningiomas, from biology to management - A literature review. Front Oncol 2023; 12:1084404. [PMID: 36713513 PMCID: PMC9880047 DOI: 10.3389/fonc.2022.1084404] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Accepted: 12/22/2022] [Indexed: 01/15/2023] Open
Abstract
Meningiomas arise from arachnoidal cap cells of the meninges, constituting the most common type of central nervous system tumors, and are considered benign tumors in most cases. Their incidence increases with age, and they mainly affect females, constituting 25-46% of primary spinal tumors. Spinal meningiomas could be detected incidentally or be unraveled by various neurological symptoms (e.g., back pain, sphincter dysfunction, sensorimotor deficits). The gold standard diagnostic modality for spinal meningiomas is Magnetic resonance imaging (MRI) which permits their classification into four categories based on their radiological appearance. According to the World Health Organization (WHO) classification, the majority of spinal meningiomas are grade 1. Nevertheless, they can be of higher grade (grades 2 and 3) with atypical or malignant histology and a more aggressive course. To date, surgery is the best treatment where the big majority of meningiomas can be cured. Advances in surgical techniques (ultrasonic dissection, microsurgery, intraoperative monitoring) increase the complete resection rate. Operated patients have a satisfactory prognosis, even in those with poor preoperative neurological status. Adjuvant therapy has a growing role in treating spinal meningiomas, mainly in the case of subtotal resection and tumor recurrence. The current paper reviews the fundamental epidemiological and clinical aspects of spinal meningiomas, their histological and genetic characteristics, and their management, including the various surgical novelties and techniques.
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Affiliation(s)
- Nicolas Serratrice
- Institut de la Colonne Vertébrale et des Neurosciences (ICVNS), Centre Médico-Chirurgical Bizet, Paris, France
| | - Imène Lameche
- Institut de la Colonne Vertébrale et des Neurosciences (ICVNS), Centre Médico-Chirurgical Bizet, Paris, France
| | - Christian Attieh
- Institut de la Colonne Vertébrale et des Neurosciences (ICVNS), Centre Médico-Chirurgical Bizet, Paris, France
| | - Moussa A Chalah
- Institut de la Colonne Vertébrale et des Neurosciences (ICVNS), Centre Médico-Chirurgical Bizet, Paris, France,EA 4391, Excitabilité Nerveuse et Thérapeutique, Faculté de Santé, Université Paris Est, Créteil, France,Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon
| | - Joe Faddoul
- Institut de la Colonne Vertébrale et des Neurosciences (ICVNS), Centre Médico-Chirurgical Bizet, Paris, France,Service de Neurochirurgie, Centre Hospitalier de la Côte Basque, Bayonne, France
| | - Bilal Tarabay
- Institut de la Colonne Vertébrale et des Neurosciences (ICVNS), Centre Médico-Chirurgical Bizet, Paris, France
| | - Rabih Bou-Nassif
- Department of Neurosurgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Youssef Ali
- Institut de Chirurgie Osseuse et de Neurochirurgie, Médipole-Montagard, Avignon, France
| | - Joseph G Mattar
- Institut de la Colonne Vertébrale et des Neurosciences (ICVNS), Centre Médico-Chirurgical Bizet, Paris, France
| | - François Nataf
- Service de Neurochirurgie, Hôpital Lariboisière, Paris, France
| | - Samar S Ayache
- Institut de la Colonne Vertébrale et des Neurosciences (ICVNS), Centre Médico-Chirurgical Bizet, Paris, France,EA 4391, Excitabilité Nerveuse et Thérapeutique, Faculté de Santé, Université Paris Est, Créteil, France,Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon,Service de Physiologie-Explorations Fonctionnelles, DMU FIxIT, Hôpital Henri Mondor, Créteil, France
| | - Georges N Abi Lahoud
- Institut de la Colonne Vertébrale et des Neurosciences (ICVNS), Centre Médico-Chirurgical Bizet, Paris, France,Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, Lebanon,*Correspondence: Georges N Abi Lahoud,
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Hachem LD, Nater A, Fehlings MG. Spinal Meningiomas. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1416:69-78. [PMID: 37432620 DOI: 10.1007/978-3-031-29750-2_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
Spinal meningiomas are relatively rare, but account for a significant proportion of primary spinal tumors in adults. These meningiomas can be found anywhere along the spinal column and their diagnosis is often delayed due to their slow growth and the lack of significant neurological symptoms until they reach a critical size, at which point signs of spinal cord or nerve root compression generally manifest and progress. If left untreated, spinal meningiomas can cause severe neurological deficits including rendering patients paraplegic or tetraplegic. In this chapter we will review the clinical features of spinal meningiomas, their surgical management, and detail molecular features that differentiate them from intracranial meningiomas.
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Affiliation(s)
- Laureen D Hachem
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Anick Nater
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Michael G Fehlings
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.
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di Bonaventura R, Caccavella VM, Latour K, Rapisarda A, Gessi M, Montano N, Visocchi M, Olivi A, Polli FM. Spinal Epidural Atypical Meningioma: Case Report and Review of the Literature. ACTA NEUROCHIRURGICA. SUPPLEMENT 2023; 135:369-373. [PMID: 38153495 DOI: 10.1007/978-3-031-36084-8_56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2023]
Abstract
Spinal atypical meningiomas are rare, and those whose main extension is in the epidural space are anecdotal. Here, we report a case of a young woman presenting with sensory disturbances and a radiological diagnosis of a dorsal epidural sleeve-like mass. The surgical resection of the lesion allowed the decompression of the spinal cord and led to the histopathological diagnosis of atypical meningioma. At the 3-month follow-up, her neurological recovery was complete. Because of the gross total removal of the lesion, adjuvant radiotherapy was not performed: At the 2-year follow-up, no recurrence of disease was detected. A comprehensive literature review was performed, and just two more case reports on epidural atypical meningiomas were found in the English literature. Through this case report and literature review, we described a rare manifestation of spinal meningioma that entered into a differential diagnosis for extradural spinal lesions, such as secondary malignancies.
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Affiliation(s)
- Rina di Bonaventura
- Department of Neurosurgery, Fondazione Universitaria Policlinico Agostino Gemelli IRCCS, Rome, Italy
- Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Valerio Mario Caccavella
- Department of Neurosurgery, Fondazione Universitaria Policlinico Agostino Gemelli IRCCS, Rome, Italy
- Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Kristy Latour
- Department of Neurosurgery, Fondazione Universitaria Policlinico Agostino Gemelli IRCCS, Rome, Italy
- Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Alessandro Rapisarda
- Department of Neurosurgery, Fondazione Universitaria Policlinico Agostino Gemelli IRCCS, Rome, Italy
- Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Marco Gessi
- Institute of Pathologic Anatomy, Fondazione Policlinico Agostino Gemelli IRCCS, Rome, Italy
| | - Nicola Montano
- Department of Neurosurgery, Fondazione Universitaria Policlinico Agostino Gemelli IRCCS, Rome, Italy
- Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Massimiliano Visocchi
- Department of Neurosurgery, Fondazione Universitaria Policlinico Agostino Gemelli IRCCS, Rome, Italy
- Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Alessandro Olivi
- Department of Neurosurgery, Fondazione Universitaria Policlinico Agostino Gemelli IRCCS, Rome, Italy
- Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy
| | - Filippo Maria Polli
- Department of Neurosurgery, Fondazione Universitaria Policlinico Agostino Gemelli IRCCS, Rome, Italy
- Institute of Neurosurgery, Catholic University of the Sacred Heart, Rome, Italy
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Current Knowledge on Spinal Meningiomas Epidemiology, Tumor Characteristics and Non-Surgical Treatment Options: A Systematic Review and Pooled Analysis (Part 1). Cancers (Basel) 2022; 14:cancers14246251. [PMID: 36551736 PMCID: PMC9776907 DOI: 10.3390/cancers14246251] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [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 Spinal meningiomas are the most common primary intradural spinal tumors. Although they are a separate entity, a large portion of the knowledge on spinal meningiomas is based on findings in intracranial meningiomas. Therefore, a comprehensive review of all the literature on spinal meningiomas was performed. METHODS Electronic databases were searched for all studies on spinal meningiomas dating from 2000 and onward. Findings of matching studies were pooled to strengthen the current body of evidence. RESULTS A total of 104 studies were included. The majority of patients were female (72.83%), elderly (peak decade: seventh), and had a world health organization (WHO) grade 1 tumor (95.7%). Interestingly, the minority of pediatric patients had a male overrepresentation (62.0% vs. 27.17%) and higher-grade tumors (33.3% vs. 4.3%). Sensory and motor dysfunction and pain were the most common presenting symptoms. Despite a handful of studies reporting promising findings associated with the use of non-surgical treatment options, the literature still suffers from contradictory results and limitations of study designs. CONCLUSIONS Elderly females with WHO grade 1 tumors constituted the stereotypical type of patient. Compared to surgical alternatives, the evidence for the use of non-surgical treatments is still relatively weak.
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7
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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: 0] [Impact Index Per Article: 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.
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8
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Krauss WE, Yolcu YU, Alvi MA, Moinuddin FM, Goyal A, Clarke MJ, Marsh WR, Bydon M. Clinical characteristics and management differences for grade II and III spinal meningiomas. J Neurooncol 2021; 153:313-320. [PMID: 33973145 DOI: 10.1007/s11060-021-03771-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 05/04/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE The majority of spinal meningiomas are grade I tumors, as defined by World Health Organization (WHO) classification making atypical (grade II) or anaplastic (grade III) tumors extremely rare lesions to encounter in clinical practice. Here, we present our institutional experience of management of grade II and III spinal meningiomas. METHODS Following IRB approval, we queried all available institutional electronic medical records for patients undergoing surgical resection of pathology-proven spinal meningiomas, with further review of patients with grade II and III. Variables of interest included age, sex, histological type, tumor size, symptoms at baseline, treatment characteristics, symptom resolution at the last follow-up, recurrence, NF-2 status, concurrent intracranial meningioma, and mortality. Kaplan Meier curves were constructed to study time to progression/recurrence. RESULTS A total of 188 patients undergoing surgical resection of spinal meningioma between 1988 and 2018 were identified. Among those, 172 (91.5%) patients had grade I meningioma and 16 (8.5%) patients had high grade meningiomas [grade II (15) and III (1)]. Over a median (IQR) follow-up of 8.0 years (5.1-13.0), mortality and recurrence rates were 18.8% (n = 3) and 47.1% (n = 8), respectively. In univariate analysis, adjuvant radiotherapy and thoracic segment involvement were associated with lower rates of recurrence while male sex was associated with a higher rate of recurrence. CONCLUSIONS Results showed variations in clinical outcomes for patients with high grade spinal meningiomas, especially the recurrence. Adjuvant radiotherapy and thoracic segment involvement was associated with lower rates of recurrence while recurrence ocurred at a higher rate in males.
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Affiliation(s)
- William E Krauss
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Yagiz Ugur Yolcu
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.,Department of Neurologic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, USA
| | - Mohammed Ali Alvi
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.,Department of Neurologic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, USA
| | - F M Moinuddin
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.,Department of Neurologic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, USA
| | - Anshit Goyal
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.,Department of Neurologic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, USA
| | - Michelle J Clarke
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - W Richard Marsh
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Mohamad Bydon
- Mayo Clinic Neuro-Informatics Laboratory, Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA. .,Department of Neurologic Surgery, Mayo Clinic, 200 1st Street SW, Rochester, MN, USA.
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Yolcu YU, Goyal A, Alvi MA, Moinuddin FM, Bydon M. Trends in the utilization of radiotherapy for spinal meningiomas: insights from the 2004-2015 National Cancer Database. Neurosurg Focus 2020; 46:E6. [PMID: 31153154 DOI: 10.3171/2019.3.focus1969] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 03/21/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVERecent studies have reported on the utility of radiosurgery for local control and symptom relief in spinal meningioma. The authors sought to evaluate national utilization trends in radiotherapy (including radiosurgery), investigate possible factors associated with its use in patients with spinal meningioma, and its impact on survival for atypical tumors.METHODSUsing the ICD-O-3 topographical codes C70.1, C72.0, and C72.1 and histological codes 9530-9535 and 9537-9539, the authors queried the National Cancer Database for patients in whom spinal meningioma had been diagnosed between 2004 and 2015. Patients who had undergone radiation in addition to surgery and those who had received radiation as the only treatment were analyzed for factors associated with each treatment.RESULTSFrom among 10,458 patients with spinal meningioma in the database, the authors found a total of 268 patients who had received any type of radiation. The patients were divided into two main groups for the analysis of radiation alone (137 [51.1%]) and radiation plus surgery (131 [48.9%]). An age > 69 years (p < 0.001), male sex (p = 0.03), and tumor size 5 to < 6 cm (p < 0.001) were found to be associated with significantly higher odds of receiving radiation alone, whereas a Charlson-Deyo Comorbidity Index ≥ 2 (p = 0.01) was associated with significantly lower odds of receiving radiation alone. Moreover, a larger tumor size (2 to < 3 cm, p = 0.01; 3 to < 4 cm, p < 0.001; 4 to < 5 cm, p < 0.001; 5 to < 6 cm, p < 0.001; and ≥ 6 cm, p < 0.001; reference = 1 to < 2 cm), as well as borderline (p < 0.001) and malignant (p < 0.001) tumors were found to be associated with increased odds of undergoing radiation in addition to surgery. Receiving adjuvant radiation conferred a significant reduction in overall mortality among patients with borderline or malignant spinal meningiomas (HR 2.12, 95% CI 1.02-4.1, p = 0.02).CONCLUSIONSThe current analysis of cases from a national cancer database revealed a small increase in the use of radiation for the management of spinal meningioma without a significant increase in overall survival. Larger tumor size and borderline or malignant behavior were found to be associated with increased radiation use. Data in the present analysis failed to show an overall survival benefit in utilizing adjuvant radiation for atypical tumors.
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Voldřich R, Netuka D, Beneš V. Spinal meningiomas: is Simpson grade II resection radical enough? Acta Neurochir (Wien) 2020; 162:1401-1408. [PMID: 32166387 DOI: 10.1007/s00701-020-04280-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 02/27/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND The optimal treatment for spinal meningioma is complete resection. The radicality of resection is the most important predictive factor for future tumor recurrence. Although clinical series dedicated to spinal meningiomas are relatively frequent, only a minimum of these defines the length of the required follow-up and difference in tumor recurrence in the context of Simpson grade I and II resection. Therefore, we propose reconsideration of surgical treatment and long-term follow-up based on a retrospective analysis of 84 patients who underwent Simpson grade II resection. METHODS The study included 84 patients operated between 1998 and 2018. Clinical symptomatology, age, sex, risk of comorbidities, spinal level, duration of symptoms, surgical resection radicality, tumor recurrence, and complications associated with treatment were recorded and evaluated. RESULTS We encountered the diagnosis of spinal meningioma considerably more often in women (81%) than in men (19%). The average age of all patients was 65 years. Most meningiomas were located in the thoracic spine (82%) while the rest (18%) were located in the cervical spine. The most common symptoms were motor deficit (80%) and sensation disorders (70%). Of the symptomatic patients, 71% clinically improved, 27% showed no change and 2% worsened postoperatively. The mean follow-up was 32 months (range 1-204). During this period, there was a 5% tumor recurrence rate. However, when we analyzed a subgroup of nine patients who were monitored for more than 6 years, tumor recurrence was diagnosed in 44%, all of whom were women (mean age 51 years). CONCLUSION Our results indicate that tumor recurrence after Simpson II resection could be significantly higher than previously thought if the follow-up is long enough, especially in younger patients. This finding suggests we consider using radical Simpson grade I resection more frequently. The study also demonstrates that after spinal meningioma surgery the patients should be followed and monitored on a long-term basis.
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Affiliation(s)
- Richard Voldřich
- Department of Neurosurgery and Neuro-oncology, First Medical Faculty, Central Military Hospital, Charles University in Prague, U Vojenské nemocnice 1200/1, 169 02, Prague 6, Czech Republic
| | - David Netuka
- Department of Neurosurgery and Neuro-oncology, First Medical Faculty, Central Military Hospital, Charles University in Prague, U Vojenské nemocnice 1200/1, 169 02, Prague 6, Czech Republic.
| | - Vladimír Beneš
- Department of Neurosurgery and Neuro-oncology, First Medical Faculty, Central Military Hospital, Charles University in Prague, U Vojenské nemocnice 1200/1, 169 02, Prague 6, Czech Republic
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11
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Barber SM, Konakondla S, Nakhla J, Fridley JS, Xia J, Oyelese AA, Telfeian AE, Gokaslan ZL. Oncologic benefits of dural resection in spinal meningiomas: a meta-analysis of Simpson grades and recurrence rates. J Neurosurg Spine 2019; 32:441-451. [PMID: 31703204 DOI: 10.3171/2019.8.spine19859] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Accepted: 08/21/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE While resection of the dural attachment has been shown by Simpson and others to reduce recurrence rates for intracranial meningiomas, the oncological benefit of dural resection for spinal meningiomas is less clear. The authors performed a systematic analysis of the literature, comparing recurrence rates for patients undergoing various Simpson grade resections of spinal meningiomas to better understand the role of dural resection on outcomes after resection of spinal meningiomas. METHODS The PubMed/Medline database was systematically searched to identify studies describing oncological and clinical outcomes after Simpson grade I, II, III, or IV resections of spinal meningiomas. RESULTS Thirty-two studies describing the outcomes of 896 patients were included in the analysis. Simpson grade I, grade II, and grade III/IV resections were performed in 27.5%, 64.6%, and 7.9% of cases, respectively. The risk of procedure-related complications (OR 4.75, 95% CI 1.27-17.8, p = 0.021) and new, unexpected postoperative neurological deficits (OR ∞, 95% CI NaN-∞, p = 0.009) were both significantly greater for patients undergoing Simpson grade I resections when compared with those undergoing Simpson grade II resections. Tumor recurrence was seen in 2.8%, 4.1%, and 39.4% of patients undergoing Simpson grade I, grade II, and grade III/IV resections over a mean radiographic follow-up period of 99.3 ± 46.4 months, 95.4 ± 57.1 months, and 82.4 ± 49.3 months, respectively. No significant difference was detected between the recurrence rates for Simpson grade I versus Simpson grade II resections (OR 1.43, 95% CI 0.61-3.39, p = 0.43). A meta-analysis of 7 studies directly comparing recurrence rates for Simpson grade I and II resections demonstrated a trend toward a decreased likelihood of recurrence after Simpson grade I resection when compared with Simpson grade II resection, although this trend did not reach statistical significance (OR 0.56, 95% CI 0.23-1.36, p = 0.20). CONCLUSIONS The results of this analysis suggest with a low level of confidence that the rates of complications and new, unexpected neurological deficits after Simpson grade I resection of spinal meningiomas are greater than those seen with Simpson grade II resections, and that the recurrence rates for Simpson grade I and grade II resections are equivalent, although additional, long-term studies are needed before reliable conclusions may be drawn.
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Affiliation(s)
- Sean M Barber
- 1Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
- 2Department of Neurosurgery, Houston Methodist Neurological Institute, Houston Methodist Hospital, Houston, Texas; and
| | - Sanjay Konakondla
- 1Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Jonathan Nakhla
- 1Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Jared S Fridley
- 1Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Jimmy Xia
- 3Weill Cornell Medical College, New York, New York
| | - Adetokunbo A Oyelese
- 1Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Albert E Telfeian
- 1Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
| | - Ziya L Gokaslan
- 1Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island
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