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Hamza M, Elia A, Paun L, Hudelist B, Schumacher X, Demasi M, Oppenheim C, Chretien F, Zanello M, Roux A, Pallud J. Predictors of functional outcomes following spinal meningioma surgery. A single-center retrospective experience of 59 cases. Neurochirurgie 2024; 70:101577. [PMID: 38909550 DOI: 10.1016/j.neuchi.2024.101577] [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: 04/05/2024] [Revised: 05/26/2024] [Accepted: 06/04/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND To better predict the postoperative functional outcomes of patients operated on for a spinal meningioma, we assessed: 1) the prevalence of good and poor postoperative functional outcomes following surgery; 2) the impact of age and frailty on postoperative functional outcomes. METHODS In this retrospective cohort study, we screened adult patients operated on for a spinal meningioma from 2005 to 2022. Inclusion criteria were: 1) patients ≥18 years; 2) histopathological diagnosis of meningioma; 3) location to the cervical, thoracic or lumbar spine (foramen magnum meningioma excluded); 4) surgery as first-line treatment; and 5) available postoperative follow-up ≥1 year. Clinical outcomes were assessed using the modified McCormick scale preoperatively and at one-year of postoperative follow-up. RESULTS In this single institution experience of 59 cases, we found that: 1) surgical resection positively impacts patients' functional outcomes, 91.2% either showing an improved or maintained good postoperative neurological status defined by a modified McCormick scale score ≤ II; 2) a good modified McCormick scale status was achieved in 84.2% of patients at one postoperative year; 3) 87.5% of patients who were not improved postoperatively maintained an overall good neurological status defined by a modified McCormick scale score ≤ II; and 4) frail or aged patients were not at a higher risk of poor postoperative functional outcomes. CONCLUSION Surgical resection positively impacts outcomes of patients operated for a spinal meningioma. Sex, presence of a meningioma-related myelopathy, extent of resection, and occurrence of surgery-related postoperative complications, but not age or frailty, predict postoperative functional outcomes.
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Affiliation(s)
- Meissa Hamza
- Service de Neurochirurgie, GHU-Paris Psychiatrie et Neurosciences, Site Sainte Anne, F-75014 Paris, France
| | - Angela Elia
- Service de Neurochirurgie, GHU-Paris Psychiatrie et Neurosciences, Site Sainte Anne, F-75014 Paris, France; Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, IMA-Brain, F-75014 Paris, France
| | - Luca Paun
- Service de Neurochirurgie, GHU-Paris Psychiatrie et Neurosciences, Site Sainte Anne, F-75014 Paris, France
| | - Benoit Hudelist
- Service de Neurochirurgie, GHU-Paris Psychiatrie et Neurosciences, Site Sainte Anne, F-75014 Paris, France
| | - Xavier Schumacher
- Service de Neurochirurgie, GHU-Paris Psychiatrie et Neurosciences, Site Sainte Anne, F-75014 Paris, France
| | - Marco Demasi
- Service de Neurochirurgie, GHU-Paris Psychiatrie et Neurosciences, Site Sainte Anne, F-75014 Paris, France
| | - Catherine Oppenheim
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, IMA-Brain, F-75014 Paris, France; Service de Neuroradiologie, GHU Paris Psychiatrie et Neurosciences, Site Sainte Anne, F-75014 Paris, France
| | - Fabrice Chretien
- Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, IMA-Brain, F-75014 Paris, France; Service de Neuropathologie, GHU Paris Psychiatrie et Neurosciences, Site Sainte Anne, F-75014 Paris, France
| | - Marc Zanello
- Service de Neurochirurgie, GHU-Paris Psychiatrie et Neurosciences, Site Sainte Anne, F-75014 Paris, France; Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, IMA-Brain, F-75014 Paris, France
| | - Alexandre Roux
- Service de Neurochirurgie, GHU-Paris Psychiatrie et Neurosciences, Site Sainte Anne, F-75014 Paris, France; Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, IMA-Brain, F-75014 Paris, France
| | - Johan Pallud
- Service de Neurochirurgie, GHU-Paris Psychiatrie et Neurosciences, Site Sainte Anne, F-75014 Paris, France; Université Paris Cité, Institute of Psychiatry and Neuroscience of Paris (IPNP), INSERM U1266, IMA-Brain, F-75014 Paris, France.
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Hsieh PC, Lu JCY, Huang SC, Toh CH, Kuo HC. Unusual clinical presentation of cervical extradural meningioma detected with neuromuscular ultrasound: A case report. Exp Ther Med 2024; 27:205. [PMID: 38590559 PMCID: PMC11000052 DOI: 10.3892/etm.2024.12493] [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: 05/12/2023] [Accepted: 02/12/2024] [Indexed: 04/10/2024] Open
Abstract
Extradural meningiomas are rare in the cervical region. A total of 70-77% of reported cases have occurred in the thoracic region. Tumors that occur in the cervical region may invade the adjacent nerve root and brachial plexus. Typically, diagnoses of extradural meningioma are made after patients present with signs of myelopathy, such as progressive paresis and numbness. In the current study, a 64-year-old male patient presented with neck pain, numbness and mild weakness in the left hand over a 6-month period. The general neurological examination was unremarkable, except for mild grasping weakness on the left side. Needle electromyography revealed complex repetitive discharges in the left 5 and 6th cervical paraspinal muscles. Neuromuscular ultrasound revealed a lesion over the left 7th cervical root, which enabled the early detection of an extradural meningioma before notable focal neurological defects developed. The patient underwent a subtotal tumor excision, followed by radiotherapy for residual tumor. Histopathological examination confirmed atypical meningioma.
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Affiliation(s)
- Pei-Chen Hsieh
- Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center, Taoyuan 333, Taiwan, R.O.C
| | - Johnny Chuieng-Yi Lu
- Department of Plastic and Reconstructive Surgery, Division of Reconstructive Microsurgery, Chang Gung Memorial Hospital at Linkou Medical Center, Taoyuan 333, Taiwan, R.O.C
| | - Shih-Chiang Huang
- Department of Anatomical Pathology, Chang Gung Memorial Hospital at Linkou Medical Center, Taoyuan 333, Taiwan, R.O.C
| | - Cheng Hong Toh
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou Medical Center, Taoyuan 333, Taiwan, R.O.C
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan, R.O.C
| | - Hung-Chou Kuo
- Department of Neurology, Chang Gung Memorial Hospital at Linkou Medical Center, Taoyuan 333, Taiwan, R.O.C
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan, R.O.C
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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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Randhawa AS, Srivastava A, Agrawal S, Verma JS, Sharma BS, Sherpa TD. Functional outcomes in intradural extramedullary spinal tumors. Surg Neurol Int 2024; 15:114. [PMID: 38742010 PMCID: PMC11090563 DOI: 10.25259/sni_689_2023] [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: 08/16/2023] [Accepted: 01/10/2024] [Indexed: 05/16/2024] Open
Abstract
Background Intradural extramedullary (IDEM) spinal cord tumors account for approximately two-thirds of benign intraspinal neoplasms. These are amenable to gross total excision but can have variable functional outcomes, which plays a key role in assessing their impact on a patient's quality of life. Understanding the functional outcomes associated with these tumors is crucial for healthcare professionals to devise appropriate treatment plans and provide comprehensive care. Methods In this study, we retrospectively reviewed the outcomes of 130 patients with IDEM tumors who underwent surgery in the past six years between January 2017 and December 2022 at a single institution. Patient demographics, symptoms, and tumor characteristics (anatomical and pathological) in all operated spinal IDEM tumors were analyzed. The neurological findings obtained during the preoperative stage and the postoperative follow-up were evaluated according to the Frankel grading. The back pain was assessed using the Denis pain scale (DPS). Results The age range, gender distribution, presentation, histopathology, and tumor characteristics were analyzed. The histopathological outcomes of the study were as follows: 56 cases of schwannoma, 37 cases of meningiomas, 16 patients of neurofibroma, six cases of epidermoid cyst, five cases each of ependymoma and dermoid cyst, three cases of arachnoid cyst, two cases of metastasis, and one case of paraganglioma. Pain was the most common symptom (38.5%), followed by weakness in limbs (31.5%), paresthesia/numbness (22.3%), and sphincter disturbance (7.7%). Complete total resection was seen in 93% of cases, with 7% undergoing subtotal excision. The complications encountered were - four cases of surgical site infection and one case each of cerebrospinal fluid leak, pseudomeningocele, and epidural hematoma. In our series, 49.3% of patients had significantly good improvement in functional outcomes as per improvement in Frankel score, and 43% of patients had good functional improvement. Significant functional improvement was noted at immediate postoperative follow-up, 2-week follow-up, and six-month follow-up periods. Reoccurrence was seen in 7 cases (5.4%). The DPS score mean values showed a significant decrease over the follow-up duration as compared to preoperative mean values. Significantly poor outcome was seen in IDEM tumours present anteriorly. Conclusion The IDEM tumors are usually benign and are readily detected by contrast-enhanced magnetic resonance imaging scans. These have variable functional outcomes in different centers. Assessing this functional outcome is an essential aspect of managing IDEM spinal tumors. It was observed through our study that the ventral location of the tumor, thoracic tumors, and poor preoperative neurological status of the patient correspond with poorer postoperative functional outcomes. Furthermore, a significant decrease in the pain symptoms with improvement of Frankel score was seen postoperatively, thus this being suggestive of a significant improvement of functional outcome after surgery. This study helps to conclude that the morbidity associated with the resection of IDEM tumors is not as significant as originally thought to be.
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Affiliation(s)
- Anmol Singh Randhawa
- Department of Neurosurgery, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, Rajasthan, India
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Said W, Maragno E, Leibrandt L, Spille D, Schipmann S, Stummer W, Gallus M, Schwake M. A Retrospective Cohort Study Evaluating the Comparative Effectiveness of Unilateral Hemilaminectomy and Bilateral Laminectomy in the Resection of Spinal Meningiomas. Oper Neurosurg (Hagerstown) 2024:01787389-990000000-01069. [PMID: 38376184 DOI: 10.1227/ons.0000000000001099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 12/20/2023] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND AND OBJECTIVES The primary treatment modality for spinal meningiomas (SM) is surgical resection. In recent years, minimal invasive spine surgery has gained considerable popularity, attributing its growth to advancements in surgical technologies and improved training of surgeons. Nonetheless, the suitability and effectiveness of minimal invasive spine surgery for intradural spinal tumor resection remain a subject of debate. In this cohort study, we aimed to compare the extent of resection of the unilateral hemilaminectomy approach, a less invasive technique, with the more traditional and invasive bilateral laminectomy. METHODS We performed a retrospective cohort study including patients with SM who underwent surgery at our department between 1996 and 2020. Cohorts included patients who underwent tumor resection through bilateral laminectomy and patients who underwent a unilateral hemilaminectomy. The primary end point was extent of resection according to the Simpson classification. RESULTS Of 131 with SM, 36 had a bilateral laminectomy and 95 were operated through a unilateral hemilaminectomy. In both groups, gross total resection, Simpson grades 1 and 2, was achieved in 94.44% and 94.74%, respectively (P = .999). The neurological outcome was also comparable in both cohorts (P = .356). Both length of hospital stay and estimated blood loss were significantly lower in the unilateral cohort (P < .05). CONCLUSION The results of this study indicate that the unilateral hemilaminectomy yields comparable results in both oncological and neurological outcome when compared with the bilateral laminectomy. Thus, unilateral hemilaminectomy may serve as a viable and safe alternative for the surgical removal of SM.
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Affiliation(s)
- Wesam Said
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Emanuele Maragno
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Lara Leibrandt
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Dorothee Spille
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Stephanie Schipmann
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
- Department of Neurosurgery, University Hospital Bergen, Bergen, Norway
| | - Walter Stummer
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
| | - Marco Gallus
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
- Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA
| | - Michael Schwake
- Department of Neurosurgery, University Hospital Münster, Münster, Germany
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Rabi K, Alhammouri S, Saa S. Unraveling the Enigma: A Report of a Rare Case of Acute Cord Syndrome Caused by Spinal Meningioma. Cureus 2023; 15:e48191. [PMID: 38050491 PMCID: PMC10693653 DOI: 10.7759/cureus.48191] [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] [Accepted: 11/02/2023] [Indexed: 12/06/2023] Open
Abstract
Spinal meningiomas (SMs) are a prevalent subtype of central nervous system tumors, with the majority adhering to the dura mater. In this case, we present the case of a 72-year-old female who initially reported numbness in her legs and the gradual onset of gait disturbances. Over a three-week period, these symptoms progressively worsened until she experienced a sudden onset of weakness and neurological deficits, leading to the diagnosis of acute cord syndrome (ACS). Magnetic resonance imaging revealed an anomaly within the extramedullary space, precisely located at the T8-T9 level. This anomaly exhibited peripheral gadolinium enhancement and demonstrated a dural tail sign, indicating the presence of an abnormal mass. Furthermore, a dorsal spine CT scan confirmed these findings by revealing a hyperdense lesion localized within the T8-T9 region. The lesion was situated posterior to the spinal cord, and conspicuous alterations in the coloration of the dura mater at the corresponding level were evident. A complete surgical resection was performed successfully, and the patient's surgical intervention proceeded without complications. Following the surgery, we observed significant improvements in both sensory and motor functions compared to the patient's preoperative state.
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Affiliation(s)
- Karam Rabi
- Department of Medicine, Faculty of Medicine & Health Sciences, An-Najah National University, Nablus, PSE
- Department of Neurosurgery, Palestinian Medical Complex, Ramallah, PSE
| | - Shams Alhammouri
- Department of Neurosurgery, Palestinian Medical Complex, Ramallah, PSE
| | - Shadi Saa
- Department of Neurosurgery, Palestinian Medical Complex, Ramallah, PSE
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Costa P, Borio A, Marmolino S, Turco C, Serpella D, Della Cerra E, Cipriano E, Ferlisi S. The role of intraoperative extensor digitorum brevis muscle MEPs in spinal surgery. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:3360-3369. [PMID: 37336795 DOI: 10.1007/s00586-023-07811-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 04/11/2023] [Accepted: 06/03/2023] [Indexed: 06/21/2023]
Abstract
PURPOSE Intraoperative muscle motor evoked potentials (m-MEPs) are widely used in spinal surgery with the aim of identifying a damage to spinal cord at a reversible stage. Generally, lower limb m-MEPs are recorded from abductor hallucis [AH] and the tibialis anterior [TA]. The purpose of this work is to study an unselected population by recording the m-MEPs from TA, AH and extensor digitorum brevis (EDB), with the aim of identifying the most adjustable and stable muscles responses intraoperatively. METHODS Transcranially electrically induced m-MEPs were intraoperative recorded in a total of 107 surgical procedures. m-MEPs were recorded by a needle electrode placed in the muscle from TA, AH and EDB muscles in the lower extremities. RESULTS Overall monitorability (i.e., at least 1 Lower Limb m-MEP recordable) was 100/107 (93.5%). In the remaining 100 surgeries in 3 cases, the only muscle that could be recorded at baseline was one AH, and in other 2 the EDB. Persistence (i.e., the recordability of m-MEP from baseline to the end of surgery) was 88.7% for TA, 89.8% for AH and 93.8% for EDB. CONCLUSION In our series, EDB m-MEPs have demonstrated a recordability superior to TA and a stability similar to AH. The explanations may be different and range from changes in the excitability of the cortical motor neuron to the different sensitivity to ischemia of the spinal motor neuron. EDB can be used alternatively or can be added to TA and AH as a target muscle of the lower limb in spinal surgery.
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Affiliation(s)
- Paolo Costa
- Department of Neurosciences and Mental Health, Section of Clinical Neurophysiology, Città della Salute e della Scienza, Turin, EU, Italy.
| | - Alessandro Borio
- Department of Neurosciences and Mental Health, Section of Clinical Neurophysiology, Città della Salute e della Scienza, Turin, EU, Italy
| | - Sonia Marmolino
- Department of Neurosciences and Mental Health, Section of Clinical Neurophysiology, Città della Salute e della Scienza, Turin, EU, Italy
| | - Cristina Turco
- Department of Neurosciences and Mental Health, Section of Clinical Neurophysiology, Città della Salute e della Scienza, Turin, EU, Italy
| | - Domenico Serpella
- Department of Neurosciences and Mental Health, Section of Clinical Neurophysiology, Città della Salute e della Scienza, Turin, EU, Italy
| | - Elena Della Cerra
- Department of Neurosciences and Mental Health, Section of Clinical Neurophysiology, Città della Salute e della Scienza, Turin, EU, Italy
| | - Elia Cipriano
- Department of Translational Medicine, Section of Neurology, University of Piemonte Orientale, Novara, Italy
| | - Salvatore Ferlisi
- Department of Biomedicine, Neurosciences and Advanced Diagnostic (BiND), University of Palermo, Palermo, Italy
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Ravindra VM, Schmidt MH. Spinal Meningiomas: Diagnosis, Surgical Management, and Adjuvant Therapies. Neurosurg Clin N Am 2023; 34:425-435. [PMID: 37210131 DOI: 10.1016/j.nec.2023.02.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Meningiomas of the spinal canal are the most common intradural spinal canal tumors encountered in adults and account for 8% of all meningiomas. Patient presentation can vary considerably. Once diagnosed, these lesions are primarily treated surgically, but depending on location and pathological features, chemotherapy and radiosurgery may be required. Emerging modalities may represent adjuvant therapies. In this article, we review the current management of meningiomas of the spinal column.
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Affiliation(s)
- Vijay M Ravindra
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 North Medical Drive East, Salt Lake City, UT 84132, USA; Department of Neurosurgery, University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; Department of Neurosurgery, Naval Medical Center San Diego, 34800 Bob Wilson Drive, San Diego, CA 92134, USA
| | - Meic H Schmidt
- Department of Neurosurgery, University of New Mexico, 1155 University Bldvd. Southeast, Albuquerque, NM 87131, USA.
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Kilinc F, Setzer M, Prinz V, Jussen D, Marquardt G, Gessler F, Czabanka M, Freiman T, Dubinski D, Won SY, Haberland M, Behmanesh B. The Beneficial Effect of Preoperative Exercise on Postoperative Clinical Outcome, Quality of Life and Return to Work after Microsurgical Resection of Spinal Meningiomas. J Clin Med 2023; 12:jcm12082804. [PMID: 37109141 PMCID: PMC10146916 DOI: 10.3390/jcm12082804] [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: 02/19/2023] [Revised: 04/02/2023] [Accepted: 04/04/2023] [Indexed: 04/29/2023] Open
Abstract
OBJECTIVE While outcomes of surgical treatment for spinal meningiomas are well-described within the literature, factors affecting early return to work as well as long-term health related quality of life remain unclear. METHODS In this retrospective study, patients with spinal meningioma and surgical treatment from two university-level neurosurgical institutions between 2008 and 2021 were analyzed. Time to return to work, physical activities and long-term health related quality of life (assessed by telephone interviews using the EQ-5D-5L health status measure and visual analogue scale (EQ VAS) were analyzed. RESULTS We identified a total of 196 patients who underwent microsurgical resection of spinal meningioma between January 2008 and December 2021. Of those, 130 patients of working age were included and analyzed. The median follow-up time was 96 months. All included patients returned to work. The median time of return to work was 45 days for the whole cohort. Patients who preoperatively performed physical activity returned to work significantly earlier compared to patients who did not (p < 0.001). Furthermore, younger age (p = 0.033) and absence of obesity (p = 0.023) correlated significantly with earlier return to work. Significant differences were also observed in all 5 EQ-5D-5L dimensions between patients with and without preoperative physical activity. CONCLUSIONS Despite the benign nature of spinal meningioma preoperative physical activity and physiological body weight are associated with favorable postoperative outcome, higher quality of life and early return to work.
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Affiliation(s)
- Fatma Kilinc
- Department of Neurosurgery, University Hospital Frankfurt, Schleusenweg 2-16, 60528 Frankfurt am Main, Germany
- Department of Neurosurgery, Goethe University Hospital, 60528 Frankfurt am Main, Germany
| | - Matthias Setzer
- Department of Neurosurgery, Goethe University Hospital, 60528 Frankfurt am Main, Germany
| | - Vincent Prinz
- Department of Neurosurgery, Goethe University Hospital, 60528 Frankfurt am Main, Germany
| | - Daniel Jussen
- Department of Neurosurgery, Goethe University Hospital, 60528 Frankfurt am Main, Germany
| | - Gerhard Marquardt
- Department of Neurosurgery, Goethe University Hospital, 60528 Frankfurt am Main, Germany
| | - Florian Gessler
- Department of Neurosurgery, University Medicine Rostock, 18057 Rostock, Germany
| | - Marcus Czabanka
- Department of Neurosurgery, Goethe University Hospital, 60528 Frankfurt am Main, Germany
| | - Thomas Freiman
- Department of Neurosurgery, University Medicine Rostock, 18057 Rostock, Germany
| | - Daniel Dubinski
- Department of Neurosurgery, University Medicine Rostock, 18057 Rostock, Germany
| | - Sae-Yeon Won
- Department of Neurosurgery, University Medicine Rostock, 18057 Rostock, Germany
| | - Moritz Haberland
- Department of Neurosurgery, University Medicine Rostock, 18057 Rostock, Germany
| | - Bedjan Behmanesh
- Department of Neurosurgery, University Medicine Rostock, 18057 Rostock, Germany
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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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11
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Elsamadicy AA, Reeves BC, Craft S, Sherman JJZ, Koo AB, Sayeed S, Sarkozy M, Kolb L, Lo SFL, Shin JH, Sciubba DM, Mendel E. A current review of spinal meningiomas: epidemiology, clinical presentation and management. J Neurooncol 2023; 161:395-404. [PMID: 36637710 DOI: 10.1007/s11060-023-04238-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 01/03/2023] [Indexed: 01/14/2023]
Abstract
PURPOSE To provide an up-to-date review of the epidemiology, histopathology, molecular biology, and etiology of spinal meningiomas, as well as discuss the clinical presentation, clinical evaluation, and most recent treatment recommendations for these lesions. METHODS PubMed and Google Scholar search was performed for studies related to meningiomas of the spine. The terms "meningioma," "spinal meningioma," "spine meningioma," "meningioma of the spine," "benign spinal tumors," and "benign spine tumors," were used to identify relevant studies. All studies, including primary data papers, meta-analyses, systematic reviews, general reviews, case reports, and clinical trials were considered for review. RESULTS Eighty-four studies were identified in the review. There were 22 studies discussing adverse postoperative outcomes, 21 studies discussing tumor genetics, 19 studies discussing epidemiology and current literature, 9 studies discussing radiation modalities and impact on subsequent tumor development, 5 studies on characteristic imaging findings, 5 studies discussing hormone use/receptor status on tumor development, 2 discussing operative techniques and 1 discussing tumor identification. CONCLUSION Investigations into spinal meningiomas generally lag behind that of intracranial meningiomas. Recent advancements in the molecular profiling of spinal meningiomas has expanded our understanding of these tumors, increasing our appreciation for their heterogeneity. Continued investigation into the defining characteristics of different spinal meningiomas will aid in treatment planning and prognostication.
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Affiliation(s)
- Aladine A Elsamadicy
- Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA.
| | - Benjamin C Reeves
- Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Samuel Craft
- Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Josiah J Z Sherman
- Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Andrew B Koo
- Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Sumaiya Sayeed
- Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Margot Sarkozy
- Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Luis Kolb
- Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
| | - Sheng-Fu Larry Lo
- Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, NY, USA
| | - John H Shin
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel M Sciubba
- Department of Neurosurgery, Zucker School of Medicine at Hofstra, Long Island Jewish Medical Center and North Shore University Hospital, Northwell Health, Manhasset, NY, USA
| | - Ehud Mendel
- Department of Neurosurgery, Yale University School of Medicine, 333 Cedar Street, New Haven, CT, 06520, USA
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12
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Haddad AF, Safaee MM, Pereira MP, Oh JY, Lau D, Tan LA, Clark AJ, Chou D, Mummaneni PV, Ames CP. Posterior-based resection of spinal meningiomas: an institutional experience of 141 patients with an average of 28 months of follow-up. J Neurosurg Spine 2023; 38:139-146. [PMID: 36152326 DOI: 10.3171/2022.7.spine211603] [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: 12/27/2021] [Accepted: 07/06/2022] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Spinal meningiomas pose unique challenges based on the location of their dural attachment. However, there is a paucity of literature investigating the role of dural attachment location on outcomes after posterior-based approach for spinal meningioma resection. The aim of this study was to investigate any differences in outcomes between dural attachment location subgroups in spinal meningioma patients who underwent posterior-based resection. METHODS This was a single-institution review of patients who underwent resection of a spinal meningioma from 1997 to 2017. Surgical, oncological, and neurological outcomes were compared between patients with varying dural attachments. Multivariate analysis was utilized. RESULTS A total of 141 patients were identified. The mean age was 62 years, and 110 women were included. The sites of dural attachments were as follows: 16 (11.3%) dorsal, 31 (22.0%) dorsolateral, 17 (12.1%) lateral, 40 (28.4%) ventral, and 37 (26.2%) ventrolateral. Most meningiomas were WHO grade I (92.2%) and in the thoracic spine (61.0%). All patients underwent a posterior approach for tumor resection. There were no differences between subgroups in terms of largest diameter of tumor resected (p = 0.201), gross-total resection (GTR) or subtotal resection (p = 0.362), Simpson grade of resection, perioperative complications (p = 0.116), long-term neurological deficit (p = 0.100), or postoperative radiation therapy (p = 0.971). Cervical spine location was associated with reduced incidence of GTR (OR 0.271, 95% CI 0.108-0.684, p = 0.006) on multivariate analysis. The overall incidence of recurrence/progression was 4.6%, with no difference (p = 0.800) between subgroups. Similarly, the average length of follow-up was 28.1 months, with no difference between subgroups (p = 0.413). CONCLUSIONS Posterior-based approaches for resection of spinal meningiomas are safe and effective, regardless of dural attachment location, with similar surgical, oncological, and neurological outcomes. Comparison of long-term recurrence rates between dural attachment subgroups is required.
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Affiliation(s)
- Alexander F Haddad
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Michael M Safaee
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Matheus P Pereira
- 2Medical Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina; and
| | - Jun Yeop Oh
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Darryl Lau
- 3Department of Neurosurgery, New York University, New York, New York
| | - Lee A Tan
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Aaron J Clark
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Dean Chou
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Praveen V Mummaneni
- 1Department of Neurological Surgery, University of California, San Francisco, California
| | - Christopher P Ames
- 1Department of Neurological Surgery, University of California, San Francisco, California
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13
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Spinal Meningioma Surgery through the Ages-Single-Center Experience over Three Decades. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58111549. [PMID: 36363510 PMCID: PMC9698896 DOI: 10.3390/medicina58111549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 10/07/2022] [Accepted: 10/25/2022] [Indexed: 11/07/2022]
Abstract
Background and Objectives: Spinal meningiomas, which are well characterized and are most frequently intradural extramedullary tumors, represent 25% of all intradural spinal tumors. The goal of this study was to compare the outcomes of surgically treated patients with spinal meningiomas in two time intervals with special emphasis on postoperative functional outcomes. Methods: Patients with spinal meningiomas admitted to our department between 1990 and 2020 were enrolled and divided into a historic cohort (HC; treated 1990−2007) and a current cohort (CC; treated 2008−2020). Patients’ clinical data and surgical and radiological reports were retrospectively analyzed up to 5 years. Preoperative and postoperative neurological function were assessed using the modified McCormick Scale (mMCS). The Charlson Comorbidity Index (CCI) was used to evaluate the effect of comorbidities on the preoperative status and postoperative outcome. Results: We included 300 patients. Participants in the CC (n = 144) were significantly younger compared to those in the HC (n = 156), with twice as many patients <50 years of age (p < 0.001). The most common tumor location was the thoracic spine (n = 204). The median follow-up was 38.1 months (±30.3 standard deviation). A symptom duration until surgery <12 months was significantly associated with an earlier improvement in the mMCS (p = 0.045). In the CC, this duration was shorter and patients’ neurological function at the first and last follow-ups was significantly better than for those in the HC (p < 0.001 for both). Conclusions: Our study results suggested that the impact of surgical management and postoperative rehabilitation on spinal meningioma patients’ long-term neurological outcome has reached important milestones over the last decades. An earlier diagnosis led to earlier surgical treatment and improved patients’ postoperative neurological recovery. Our results exposed that surgical therapy for spinal meningioma should be performed within 12 months after appearance of symptoms to achieve a better recovery.
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14
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Jamieson A, Letchuman V, Tan LA. Commentary: Microsurgical Tubular Resection of Intradural Extramedullary Spinal Tumors With 3-Dimensional-Navigated Localization. Oper Neurosurg (Hagerstown) 2022; 23:e405-e406. [PMID: 36251437 DOI: 10.1227/ons.0000000000000451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Alysha Jamieson
- Department of Neurological Surgery, University of California, San Francisco Medical Center, San Francisco, California, USA
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15
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McGrath LB, Kirnaz S, Goldberg JL, Sommer F, Medary B, Hussain I, Härtl R. Microsurgical Tubular Resection of Intradural Extramedullary Spinal Tumors With 3-Dimensional-Navigated Localization. Oper Neurosurg (Hagerstown) 2022; 23:e245-e255. [PMID: 36103347 DOI: 10.1227/ons.0000000000000365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 05/05/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The safety and efficacy of minimally invasive spine surgical (MISS) approaches have stimulated interest in adapting MISS principles for more complex pathology including intradural extramedullary (IDEM) tumors. No study has characterized a repeatable approach integrating the MISS surgical technique and 3-dimensional intraoperative navigated localization for the treatment of IDEM tumors. OBJECTIVE To describe a safe and reproducible technical guide for the navigated MISS technique for the treatment of benign intradural and extradural spinal tumors. METHODS Retrospective review of prospectively collected data on 20 patients who underwent navigated microsurgical tubular resection of intradural extramedullary tumors over a 5-year period. We review our approach to patient selection and report demographic and outcomes data for the cohort. RESULTS Our experience demonstrates technical feasibility and safety with a 100% rate of gross total resection with no patients demonstrating recurrence during an average follow-up of 20.2 months and no instances of perioperative complications. We demonstrate favorable outcomes regarding blood loss, operative duration, and hospital length of stay. CONCLUSION Navigated localization and microsurgical tubular resection of IDEM tumors is safe and effective. Adherence to MISS principles and thoughtful patient selection facilitate successful management of these patients.
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Affiliation(s)
- Lynn B McGrath
- Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York, USA
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16
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Capo G, Moiraghi A, Baro V, Tahhan N, Delaidelli A, Saladino A, Paun L, DiMeco F, Denaro L, Meling TR, Tessitore E, Barrey CY. Surgical Treatment of Spinal Meningiomas in the Elderly (≥75 Years): Which Factors Affect the Neurological Outcome? An International Multicentric Study of 72 Cases. Cancers (Basel) 2022; 14:cancers14194790. [PMID: 36230713 PMCID: PMC9563730 DOI: 10.3390/cancers14194790] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/20/2022] [Accepted: 09/26/2022] [Indexed: 11/16/2022] Open
Abstract
(1) Background: With the increasing life expectancy in the Western world, an increasing number of old patients presents with spinal meningioma. Considering the benign nature of these tumors, the functional outcome remains of great importance, since more people reach old age in general conditions of well-being and satisfactory autonomy. (2) Methods: We conducted an international multicenter retrospective study to investigate demographic, clinical and radiological data in a population of elderly patients (≥75 years of age) undergoing surgery for SM from January 2000 to December 2020 in four European referral centers. The aim was to identify prognostic and predictive factors for a good postoperative functional outcome. (3) Results: 72 patients were included in the study. Complete tumor resection (Simpson I or II) was achieved in 67 (95.7%) cases. Intraoperative complications were reported in 7 (9.9%) patients while postoperative complications were found in 12 (16.7%). An excellent general postoperative status (McCormick I and II) was achieved in 65.3%. Overall, surgical resection had a good impact on patients’ functional outcome (86.1% either showing an improvement or maintaining a good preoperative status). Uni- and multivariate analyses found that both age and preoperative modified McCormick independently correlated with relative outcome (coeff = −0.058, p = 0.0251; coeff = 0.597, p < 0.0001) and with postoperative status (coeff = 0.058, p = 0.02507; coeff = 0.402, p = 0.00027), respectively. (4) Conclusions: Age and preoperative modified McCormick were found to be independent prognostic factors. Nevertheless, advanced age (≥75), per se, did not seem to contraindicate surgery, even in those with severe preoperative neurological deficits. The functional results sustain the need for surgical resection of SM in the elderly.
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Affiliation(s)
- Gabriele Capo
- Department of Spine and Spinal Cord Surgery, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Claude Bernard University of Lyon 1, 59 Boulevard Pinel, 69677 Lyon-Bron, France
- Correspondence: ; Tel.: +33-04-72-11-90-24
| | - Alessandro Moiraghi
- Department of Neurosurgery, Geneva University Hospitals, Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland
- Department of Neurosurgery, GHU Paris—Psychiatrie et Neurosciences, Sainte-Anne Hospital, 75014 Paris, France
- Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR S1266, INSERM, IMA-BRAIN, 75014 Paris, France
| | - Valentina Baro
- Academic Neurosurgery, Department of Neurosciences, University of Padova, 35128 Padova, Italy
| | - Nadim Tahhan
- Department of Spine and Spinal Cord Surgery, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Claude Bernard University of Lyon 1, 59 Boulevard Pinel, 69677 Lyon-Bron, France
| | - Alberto Delaidelli
- Department of Molecular Oncology, British Columbia Cancer Research Centre, Vancouver, BC V5Z 1L3, Canada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC V6T 1Z7, Canada
| | - Andrea Saladino
- Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Nazionale “C. Besta”, 20133 Milan, Italy
| | - Luca Paun
- Department of Neurosurgery, Geneva University Hospitals, Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland
| | - Francesco DiMeco
- Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Nazionale “C. Besta”, 20133 Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy
- Department of Neurological Surgery, Johns Hopkins Medical School, Baltimore, MD 21205, USA
| | - Luca Denaro
- Academic Neurosurgery, Department of Neurosciences, University of Padova, 35128 Padova, Italy
| | - Torstein Ragnar Meling
- Department of Neurosurgery, Geneva University Hospitals, Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland
| | - Enrico Tessitore
- Department of Neurosurgery, Geneva University Hospitals, Faculty of Medicine, University of Geneva, 1205 Geneva, Switzerland
| | - Cédric Yves Barrey
- Department of Spine and Spinal Cord Surgery, Hôpital Pierre Wertheimer, Hospices Civils de Lyon, Claude Bernard University of Lyon 1, 59 Boulevard Pinel, 69677 Lyon-Bron, France
- Laboratory of Biomechanics, ENSAM, Arts et Metiers ParisTech, 153 Boulevard de l’Hôpital, 75013 Paris, France
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17
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Tumori spinali intradurali. Neurologia 2022. [DOI: 10.1016/s1634-7072(22)46430-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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18
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Park BJ, Dougherty MC, Noeller J, Nourski K, Gold CJ, Menezes AH, Hitchon CA, Bathla G, Yamaguchi S, Hitchon PW. Spinal meningioma in adults: Imaging characteristics, surgical outcomes, and risk factors for recurrence. World Neurosurg 2022; 164:e852-e860. [DOI: 10.1016/j.wneu.2022.05.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 05/12/2022] [Accepted: 05/13/2022] [Indexed: 10/18/2022]
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19
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Wang D, Sadek AR, Vaseeharan S, Manivannan S, Walker M, Nader-Sepahi A. Presentation and management of spinal meningioma and its association with breast carcinoma-case series and systematic review. Br J Neurosurg 2022:1-6. [PMID: 35435093 DOI: 10.1080/02688697.2022.2061419] [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: 10/25/2020] [Revised: 12/18/2021] [Accepted: 03/29/2022] [Indexed: 11/02/2022]
Abstract
OBJECTIVE Benign spinal intradural tumors are rare entities and there have been relatively few case series describing the epidemiology and characteristics of these tumors. Here, we evaluate the presentation, demographics, pathology and outcomes associated with the surgical management of spinal meningioma in our unit over a 6-year period. RESULTS A total of 68 cases presented to the operating surgeon during a 6-year period. Of these, over 80% (n = 55) were in females. Seventy-nine percent of the meningiomas were observed in the thoracic region (n = 54). Weakness and gait disturbance were the most common presenting complaints. Surgery significantly improved both motor outcome (p < 0.001) and health related qualities of life (SF36, p < 0.01).Seventeen percent of spinal meningioma cases (n = 12) had a preceding cancer diagnosis. Of these 75% (n = 9/12) were attributable to breast cancer. Overall, breast cancer preceded a diagnosis of a spinal meningioma in 16.4% of female cases (9/55). This is higher than expected number of breast cancer based on UK population and those reported in literature for breast cancer and intracranial meningioma. CONCLUSION Spinal meningioma is disproportionately over-represented in females. Patients present with neurological deficits and surgery improved both neurology and patient reported quality of life. Relative to the known UK prevalence of breast cancer, there is a significantly higher than expected association between spinal meningioma and a preceding history of breast cancer.
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Affiliation(s)
- Difei Wang
- Department of Neurosurgery, Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Division of Clinical Neurosciences, School of Medicine, University of Southampton, Southampton, UK
| | - Ahmed-Ramadan Sadek
- Department of Neurosurgery, Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Division of Clinical Neurosciences, School of Medicine, University of Southampton, Southampton, UK
- Department of Neurosurgery, Queens Hospital, Barking Havering Redbridge University Hospitals NHS Trust, Romford, UK
| | - Shathana Vaseeharan
- Division of Clinical Neurosciences, School of Medicine, University of Southampton, Southampton, UK
| | - Susruta Manivannan
- Department of Neurosurgery, Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Mark Walker
- Department of Cellular Pathology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Ali Nader-Sepahi
- Department of Neurosurgery, Wessex Neurological Centre, University Hospital Southampton NHS Foundation Trust, Southampton, UK
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20
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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.
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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.
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21
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Corell A, Cerbach C, Hoefling N, Björkman-Burtscher IM, Jakola AS. Spinal cord compression in relation to clinical symptoms in patients with spinal meningiomas. Clin Neurol Neurosurg 2021; 211:107018. [PMID: 34808478 DOI: 10.1016/j.clineuro.2021.107018] [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: 09/25/2021] [Revised: 10/25/2021] [Accepted: 10/31/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Spinal meningiomas are common primary tumors of the spinal canal and the resulting spinal cord compression (SCC) is intrinsically related to symptoms and outcome, but literature concerning this association is limited. We aimed to present data on both degree of SCC and tumor occupancy percentage in relation to neurological symptoms and outcome. METHODS Patients ≥ 18 years with a histological diagnosis of spinal canal meningioma treated between 2000 and 2017 were retrospectively evaluated for symptoms and neurological outcome in relation to SCC (i.e. compression of spinal cord at maximal tumor compression compared to maximum area above/below compression) and tumor occupancy percentage (percentage of dural sac area occupied by tumor at maximal tumor compression). Area segmentation of spinal cord, tumor and dural sac (as marker of spinal canal) was performed manually on magnetic resonance imaging (MRI) scans. The neurological deficit was assessed pre- and postoperatively according to the McCormick score. A logistic regression was made with a training set to identify the cut-off level for motor deficit. RESULTS The cohort included 111 patients with a mean age of 62.5 years and 77.5% were female. The dominating symptoms preoperatively were sensory disturbance (91.0%), motor deficit (80.2%) and gait disturbance (67.6%). Postoperatively 53.2% of patients, also in some of those with severe deficit and high tumor occupancy, improved their neurological deficit and 43.2% were unchanged. Patients with intradural meningioma and assessable MRI scans were included to evaluate SCC (n = 83). The mean extent of SCC was 50.6%. Exploration of tumor occupancy percentage identified a cut-off at 65% tumor occupancy to best discriminate between patients with or without motor deficit. CONCLUSION Patients with an intradural tumor occupancy percentage of > 65% are more likely to have a preoperative symptom and deficit, validating previous findings. Therefore, we suggest that even in asymptomatic, otherwise fit, patients with tumor occupancy approaching 65% should be considered for surgery since there is a high risk of developing deficit with even minimal growth. Concerning recovery, patients with tumor both high tumor occupancy and significantly impaired function tended to improve their functional level postoperatively.
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Affiliation(s)
- Alba Corell
- Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | | | - Nickoleta Hoefling
- Department of Radiology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Isabella M Björkman-Burtscher
- Department of Radiology, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden; Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Asgeir Store Jakola
- Department of Neurosurgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Clinical Neuroscience, Institute of Neuroscience and Physiology at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway
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22
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Ono H, Kumagai G, Wada K, Ono A, Asari T, Aoki M, Ishibashi Y. Assessing the Utility of 18F-Fluorodeoxyglucose Positron Emission Tomography in the Differential Diagnosis Between Spinal Schwannomas and Meningiomas. Cureus 2021; 13:e18890. [PMID: 34804734 PMCID: PMC8599483 DOI: 10.7759/cureus.18890] [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] [Accepted: 10/18/2021] [Indexed: 11/06/2022] Open
Abstract
Objective The advantage of 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) for the differential diagnosis of schwannoma and meningioma remains unclear. The purpose of this study was to compare the maximum standardized uptake value (SUVmax) with computed tomography (CT) and magnetic resonance imaging (MRI) findings and assess its utility in the differential diagnosis of schwannomas and meningiomas. Methods This study included 42 patients who underwent surgery and had pathological diagnoses of schwannomas (S group) or meningiomas (M group). Multivariate logistic regression analyses were conducted using meningioma prevalence as the dependent variable, and confounders were selected from those with p-values <0.05, including calcification, dural tail sign, tumor volume, and SUVmax at each spinal level as independent variables. Results The SUVmax of the spinal canal type at the level of the cervical vertebrae was significantly higher in the M group (4.6 ± 0.8) than in the S group (2.7 ± 1.4; P = 0.017). Multivariate logistic regression analysis showed that the dural tail sign was significantly associated with differential diagnosis between the S and M groups (odds ratio [OR], 0.851; 95% confidence interval [CI], 0.704-1.031, p<0.001). Conclusions The dural tail sign on MRI, but not the SUVmax of FDG-PET, was the most useful for the differential diagnosis between schwannomas and meningiomas.
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Affiliation(s)
- Hiroya Ono
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, JPN
| | - Gentarou Kumagai
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, JPN
| | - Kanichiro Wada
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, JPN
| | - Atsushi Ono
- Department of Orthopedics, Hirosaki Memorial Hospital, Hirosaki, JPN
| | - Toru Asari
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, JPN
| | - Masahiro Aoki
- Department of Radiation and Oncology, Hirosaki University Graduate School of Medicine, Hirosaki, JPN
| | - Yasuyuki Ishibashi
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, JPN
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23
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Goldbrunner R, Stavrinou P, Jenkinson MD, Sahm F, Mawrin C, Weber DC, Preusser M, Minniti G, Lund-Johansen M, Lefranc F, Houdart E, Sallabanda K, Le Rhun E, Nieuwenhuizen D, Tabatabai G, Soffietti R, Weller M. EANO guideline on the diagnosis and management of meningiomas. Neuro Oncol 2021; 23:1821-1834. [PMID: 34181733 PMCID: PMC8563316 DOI: 10.1093/neuonc/noab150] [Citation(s) in RCA: 242] [Impact Index Per Article: 80.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Meningiomas are the most common intracranial tumors. Yet, only few controlled clinical trials have been conducted to guide clinical decision making, resulting in variations of management approaches across countries and centers. However, recent advances in molecular genetics and clinical trial results help to refine the diagnostic and therapeutic approach to meningioma. Accordingly, the European Association of Neuro-Oncology (EANO) updated its recommendations for the diagnosis and treatment of meningiomas. A provisional diagnosis of meningioma is typically made by neuroimaging, mostly magnetic resonance imaging. Such provisional diagnoses may be made incidentally. Accordingly, a significant proportion of meningiomas, notably in patients that are asymptomatic or elderly or both, may be managed by a watch-and-scan strategy. A surgical intervention with tissue, commonly with the goal of gross total resection, is required for the definitive diagnosis according to the WHO classification. A role for molecular profiling including gene panel sequencing and genomic methylation profiling is emerging. A gross total surgical resection including the involved dura is often curative. Inoperable or recurrent tumors requiring treatment can be treated with radiosurgery, if the size or the vicinity of critical structures allows that, or with fractionated radiotherapy (RT). Treatment concepts combining surgery and radiosurgery or fractionated RT are increasingly used, although there remain controversies regard timing, type, and dosing of the various RT approaches. Radionuclide therapy targeting somatostatin receptors is an experimental approach, as are all approaches of systemic pharmacotherapy. The best albeit modest results with pharmacotherapy have been obtained with bevacizumab or multikinase inhibitors targeting vascular endothelial growth factor receptor, but no standard of care systemic treatment has been yet defined.
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Affiliation(s)
- Roland Goldbrunner
- Center of Neurosurgery, Department of General Neurosurgery, University of Cologne, Cologne, Germany
| | - Pantelis Stavrinou
- Neurosurgical Department, Metropolitan Hospital, Athens, Greece and Center of Neurosurgery, Department of General Neurosurgery, University of Cologne, Cologne, Germany
| | - Michael D Jenkinson
- Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, UK
| | - Felix Sahm
- Department of Neuropathology, University Hospital Heidelberg, Heidelberg, Germany
| | - Christian Mawrin
- Department of Neuropathology, University of Magdeburg, Magdeburg, Germany
| | - Damien C Weber
- Center for Proton Therapy, Paul Scherrer Institute, Villigen, Switzerland
| | - Matthias Preusser
- Department of Medicine I, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - Giuseppe Minniti
- Radiation Oncology Unit, Sant’Andrea Hospital, Sapienza University, Rome, Italy
| | - Morten Lund-Johansen
- Department of Neurosurgery, Bergen University Hospital, Bergen, Norway
- Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway
| | - Florence Lefranc
- Department of Neurosurgery, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Emanuel Houdart
- Service de Neuroradiologie, Hopital Lariboisiere, Paris, France
| | - Kita Sallabanda
- Department of Neurosurgery, University Hospital San Carlos, Universidad Complutense de Madrid, Madrid, Spain
- Hospital Clinico Universitario San Carlos, Madrid, Spain
- CyberKnife Centre, Genesiscare Madrid, Madrid, Spain
| | - Emilie Le Rhun
- Department of Neurology and Neurosurgery, Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
| | | | - Ghazaleh Tabatabai
- Center for Neurooncology, Comprehensive Cancer Center, University Hospital Tübingen, Tübingen, Germany
| | - Riccardo Soffietti
- Department of Neuro-Oncology, City of Health and Science University Hospital, Turin, Italy
| | - Michael Weller
- Department of Neurology, Clinical Neuroscience Center, University Hospital and University of Zurich, Zurich, Switzerland
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24
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Okura H, Pathmanaban ON, Munoz DG, Cusimano MD. Novel Dural-Splitting Operative Technique for Excision of Ventrally Located Spinal Meningiomas. World Neurosurg 2021; 157:48-53. [PMID: 34601172 DOI: 10.1016/j.wneu.2021.09.101] [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: 07/22/2021] [Revised: 09/23/2021] [Accepted: 09/23/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Spinal meningiomas are one of the frequently seen intradural extramedullary spinal tumors. They are almost always World Health Organization grade I, and a complete removal of the tumor can be curative. However, ventrally located spinal meningioma removal can be challenging due to the position in front of the spinal cord through a narrow corridor provided by routine dorsal approaches. Incomplete excision of the relatively inaccessible dural attachment can consequently lead to recurrence. We describe a safe and reproducible technique used to achieve Simpson grade I removal of ventrally located spinal meningioma. METHODS Since the spinal dura can be easily divided into inner and outer layers and the tumor usually spares the outer layer, we developed a simple technique to achieve total resection of the tumor and involved dura while leaving the outer dural layer intact. RESULTS An advantage of this procedure is that it exploits an interdural approach to allow early devascularization of the tumor without cord manipulation and provides access to the ventral dura to achieve Simpson grade I excision. Another advantage is complete dural closure to minimize postoperative cerebrospinal fluid leak or ventral cord herniation without the need for dural substitutes. CONCLUSION Its novel interdural approach can be used for all ages and all spinal meningiomas.
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Affiliation(s)
- Hidehiro Okura
- Division of Neurosurgery, St Michael's Hospital, University of Toronto, Toronto, Canada
| | - Omar N Pathmanaban
- Division of Neurosurgery, St Michael's Hospital, University of Toronto, Toronto, Canada
| | - David G Munoz
- Division of Neurosurgery, St Michael's Hospital, University of Toronto, Toronto, Canada
| | - Michael D Cusimano
- Division of Neurosurgery, St Michael's Hospital, University of Toronto, Toronto, Canada.
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25
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Spinal Meningiomas: Influence of Cord Compression and Radiological Features on Preoperative Functional Status and Outcome. Cancers (Basel) 2021; 13:cancers13164183. [PMID: 34439337 PMCID: PMC8393980 DOI: 10.3390/cancers13164183] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 08/12/2021] [Accepted: 08/14/2021] [Indexed: 11/17/2022] Open
Abstract
Simple Summary Patients affected by spinal meningioma globally exhibit an excellent postoperative functional outcome despite tumor size and severity of spinal cord compression. This work aims to analyze the impact of tumor size and other radiological findings on clinical functional preoperative status and postoperative outcome. In this multicentric retrospective study involving 90 adult patients, we found that spinal cord and tumor occupancy as well as cord compression and tumor volume are correlated with low preoperative functional status. Higher tumor occupancy and tumor-canal volume ratio corresponded to lower postoperative neurological recovery. Cord re-expansion did not show any correlation with postoperative outcome, while preoperative signs of cord myelopathy were predictors of worse postoperative outcome. These findings suggest that these radiological features should be taken into consideration during preoperative counselling. Abstract Background: Radiological parameters predicting the postoperative neurological outcome after resection of a spinal meningioma (SM) are poorly studied, with controversial results. Methods: Observational multicenter cohort (2011–2018) of adult patients undergoing surgery for resection of SM. Tumor-canal volume ratio (TCR), the areas related to the cord and tumor occupancy at maximum compression, the presence of dural tail, calcifications, signs of myelopathy, and postoperative cord expansion were compared with the modified McCormick scale (mMCS) preoperative and at follow-up. Results: In the cohort (n = 90 patients), cord and tumor occupancy as well as cord compression and tumor volume showed a correlation with preoperative mMCS (p < 0.05, R −0.23; p < 0.001, R 0.35; p < 0.005, R −0.29; p < 0.001, R 0.42). Cord occupancy had a strong correlation with cord compression (p < 0.001, R 0.72). Tumor occupancy and TCR were correlated with relative outcome at follow-up (p < 0.005 R 0.3; p < 0.005 R 0.29). No correlation was found between cord re-expansion and clinical outcome at follow-up. Finally, a correlation was shown between preoperative signs of cord myelopathy and mMCS (p < 0.05 R 0.21) at follow-up. Conclusions: Larger tumors showed lower preoperative functional status and a worse clinical outcome. Moreover, preoperative T2 cord signal changes are correlated with a poorer outcome.
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26
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Wach J, Banat M, Schuss P, Güresir E, Vatter H, Scorzin J. Age at Diagnosis and Baseline Myelomalacia Sign Predict Functional Outcome After Spinal Meningioma Surgery. Front Surg 2021; 8:682930. [PMID: 34277695 PMCID: PMC8282826 DOI: 10.3389/fsurg.2021.682930] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 06/07/2021] [Indexed: 11/21/2022] Open
Abstract
Objective: Spinal meningioma (SM) accounts for 12% of all meningiomas. Clinical and immunohistochemical factors were analyzed with regard to functional outcome, surgical adverse events, and tumor recurrence. Methods: One-hundred and twenty-three consecutive SM patients underwent surgery and were retrospectively reviewed with regard to demographic parameters, imaging features, neurological function, and immunohistochemical items. Neurological function was graded according to the Modified McCormick Scale (MMS) and dichotomized as “good (grade I + II)” and “poor (grade III–V)” function. Results: One-hundred and fourteen (92.7%) WHO grade I and 9 (7.3%) WHO grade II SM were included in this study. Univariate analysis identified a baseline T2 hyperintensity of the spinal cord, baseline symptom duration ≥4 weeks, age ≥66 years, and dural tail sign as predictors of poor MMS. Baseline T2 hyperintensity of the spinal cord [Odds ratio (OR) = 13.3, 95% CI = 3.4–52.1, p < 0.001] and age ≥66 years (OR = 10.3, 95% CI = 2.6–41.1, p = 0.001) were independent predictors of a poor MMS grade at discharge after SM surgery in the multivariate binary logistic regression analysis. The 12- and 24-month recurrence-free survival rates were 98.7 % (1/80) and 94.7% (2/38), respectively. In those patients with tumor recurrence of the SM, highly increased MIB-1 (≥5%) labeling indices were observed. Conclusion: Baseline T2 hyperintensity, especially in the elderly patients, is a strong predictor of poorer recovery after spinal meningioma surgery. SMs with high proliferative activity should be followed-up closely despite maximal safe resection.
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Affiliation(s)
- Johannes Wach
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Mohammed Banat
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Patrick Schuss
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Erdem Güresir
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Hartmut Vatter
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
| | - Jasmin Scorzin
- Department of Neurosurgery, University Hospital Bonn, Bonn, Germany
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27
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Clinical features and prognostic factors in spinal meningioma surgery from a multicenter study. Sci Rep 2021; 11:11630. [PMID: 34079036 PMCID: PMC8172892 DOI: 10.1038/s41598-021-91225-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 05/24/2021] [Indexed: 11/27/2022] Open
Abstract
Meningiomas are benign tumors that are treated surgically. Local recurrence is likely if the dura is preserved, and en bloc tumor and dura resection (Simpson grade I) is recommended. In some cases the dura is cauterized and preserved after tumor resection (Simpson grade II). The purpose of this study was performed to analyze clinical features and prognostic factors associated with spinal meningioma, and to identify the most effective surgical treatment. The subjects were 116 patients (22 males, 94 females) with spinal meningioma who underwent surgery at seven NSG centers between 1998 and 2018. Clinical data were collected from the NSG database. Pre- and postoperative neurological status was defined using the modified McCormick scale. The patients had a mean age of 61.2 ± 14.8 years (range 19–91 years) and mean symptom duration of 11.3 ± 14.7 months (range 1–93 months). Complete resection was achieved in 108 cases (94%), including 29 Simpson grade I and 79 Simpson grade II resections. The mean follow-up period was 84.8 ± 52.7 months. At the last follow-up, neurological function had improved in 73 patients (63%), was stable in 34 (29%), and had worsened in 9 (8%). Eight patients had recurrence, and recurrence rates did not differ significantly between Simpson grades I and II in initial surgery. Kaplan–Meier analysis of recurrence-free survival showed that Simpson grade III or IV, male, and dural tail sign were significant factors associated with recurrence (P < 0.05). In conclusion, Simpson I resection is anatomically favorable for spinal meningiomas. Younger male patients with a dural tail and a high-grade tumor require close follow-up. The tumor location and feasibility of surgery can affect the surgical morbidity in Simpson I or II resection. All patients should be carefully monitored for long-term outcomes, and we recommend lifelong surveillance after surgery.
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28
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Fiani B, Jarrah R, Griepp DW, Adukuzhiyil J. The Role of 3D Exoscope Systems in Neurosurgery: An Optical Innovation. Cureus 2021; 13:e15878. [PMID: 34327102 PMCID: PMC8302823 DOI: 10.7759/cureus.15878] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 06/23/2021] [Indexed: 12/20/2022] Open
Abstract
The development of the three-dimensional (3D) exoscope is a marvel of technological innovation in modern surgical practice. While its predecessor, the operating microscope (OM), has long been the gold-standard surgical visualization modality, its particular limitations in terms of accessibility and ergonomic demand have led to the development of a more sophisticated, 3D model. Specifically, the 3D exoscope allows for an enhanced image quality of the surgical field, while also being more ergonomically favorable. Moreover, this device's ability to handle delicate microsensitve procedures, along with its alleviation of surgeon fatigue, indicates great potential for neurosurgical application. For this narrative review, the authors queried PubMed database using the keyword "exoscope" to identify relevant studies involving the specialty of neurosurgery that were published in English language full text. The search yielded full-text English language-related articles regarding neurosurgical exoscope, its applications and limitations. The 3D exoscope uniquely allows for enhanced surgeon comfort and superior imaging of the patient's real-time anatomy. However, the OM was described to having a slight image favorability with fusion and decompression surgery. Cost analysis is highlighted for its potential disparity. 3D exoscopes will potentially be incorporated with intelligent carriers and robotic surgical systems. Ultimately, with further studies highlighting its use, the 3D exoscope is expected to continue to imprint its status as one of the most efficient technological visualization tools in the future of neurosurgical practice.
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Affiliation(s)
- Brian Fiani
- Neurosurgery, Desert Regional Medical Center, Palm Springs, USA
| | - Ryan Jarrah
- Neurosurgery, College of Arts and Sciences, University of Michigan - Flint, Flint, USA
| | - Daniel W Griepp
- Neurosurgery, College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, USA
| | - Jessica Adukuzhiyil
- Medicine, College of Osteopathic Medicine, New York Institute of Technology, Old Westbury, USA
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29
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Kilinc F, Setzer M, Marquardt G, Keil F, Dubinski D, Bruder M, Seifert V, Behmanesh B. Functional outcome and morbidity after microsurgical resection of spinal meningiomas. Neurosurg Focus 2021; 50:E20. [PMID: 33932928 DOI: 10.3171/2021.2.focus201116] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 02/17/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate functional outcome, surgical morbidity, and factors that affect outcomes of surgically treated patients. METHODS The authors retrospectively analyzed patients who underwent microsurgical resection for spinal meningiomas between 2009 and 2020. Patient data and potential variables were collected and evaluated consecutively. Functional outcomes were evaluated using univariate and multivariate analyses. RESULTS A total of 119 patients underwent microsurgical resection of spinal meningioma within the study period. After a mean follow-up of 25.4 ± 37.1 months, the rates of overall complication, tumor recurrence, and poor functional outcome were 9.2%, 7.6%, and 5%, respectively. Age, sex, revision surgery, and tumor recurrence were identified as independent predictors of poor functional outcome. Obesity and surgeon's experience had an impact on the complication rate, whereas extent of resection and tumor calcification affected the rate of tumor recurrence. CONCLUSIONS Microsurgical resection of spinal meningiomas remains safe. Nevertheless, some aspects, such as obesity and experience of the surgeons that result in a higher complication rate and ultimately affect clinical outcome, should be considered when performing surgery.
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Affiliation(s)
| | | | | | - Fee Keil
- 2Neuroradiology, Goethe-University, Frankfurt am Main, Germany
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30
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Choi EH, Chan AY, Gong AD, Hsu Z, Chan AK, Limbo JN, Hong JD, Brown NJ, Lien BV, Davies J, Satyadev N, Acharya N, Yang CY, Lee YP, Golshani K, Bhatia NN, Hsu FPK, Oh MY. Comparison of Minimally Invasive Total versus Subtotal Resection of Spinal Tumors: A Systematic Review and Meta-Analysis. World Neurosurg 2021; 151:e343-e354. [PMID: 33887496 DOI: 10.1016/j.wneu.2021.04.045] [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: 02/05/2021] [Revised: 04/09/2021] [Accepted: 04/10/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE With the advent of minimally invasive techniques, minimally invasive spine surgery (MISS) has become a realistic option for many spine cases. This study aims to evaluate the operative and clinical outcomes of MISS for total versus subtotal tumor resection from current evidence. METHODS A literature search was performed using the search term (Minimally invasive surgery OR MIS) AND (spine tumor OR spinal tumor). Studies including both minimally invasive total and subtotal resection cases with operative or clinical data were included. RESULTS Seven studies describing 159 spinal tumor cases were included. Compared with total resection, subtotal resection showed no significant differences in surgical time (mean difference (MD), 9.44 minutes; 95% confidence interval [CI], -47.66 to 66.55 minutes; P = 0.37), surgical blood loss (MD, -84.72 mL; 95% CI, -342.82 to 173.39 mL; P = 0.34), length of stay (MD, 1.38 days; 95% CI, -0.95 to 3.71 days; P = 0.17), and complication rate (odds ratio, 9.47; 95% CI, 0.34-263.56; P = 0.12). Pooled analyses with the random-effects model showed that neurologic function improved in 89% of patients undergoing total resection, whereas neurologic function improved in 61% of patients undergoing subtotal resection. CONCLUSIONS Our analyses show that there is no significant difference in operative outcomes between total and subtotal resection. Patients undergoing total resection showed slightly better improvement in neurologic outcomes compared with patients undergoing subtotal resection. Overall, this study suggests that both total and subtotal resection may result in comparable outcomes for patients with spinal tumors. However, maximal safe resection remains the ideal treatment because it provides the greatest chance of long-term benefit.
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Affiliation(s)
- Elliot H Choi
- Department of Neurological Surgery, University of California, Irvine, California, USA; Medical Scientist Training Program, School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Alvin Y Chan
- Department of Neurological Surgery, University of California, Irvine, California, USA
| | - Andrew D Gong
- Department of Neurological Surgery, University of Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Zachary Hsu
- Department of Neurological Surgery, University of California, Irvine, California, USA
| | - Andrew K Chan
- Department of Neurological Surgery, University of California, San Francisco, California, USA
| | - Joshua N Limbo
- Department of Neurological Surgery, University of California, Irvine, California, USA
| | - John D Hong
- Department of Neurological Surgery, University of California, Irvine, California, USA
| | - Nolan J Brown
- Department of Neurological Surgery, University of California, Irvine, California, USA
| | - Brian V Lien
- Department of Neurological Surgery, University of California, Irvine, California, USA
| | - Jordan Davies
- Department of Neurological Surgery, University of California, Irvine, California, USA
| | - Nihal Satyadev
- Department of Neurological Surgery, University of California, Irvine, California, USA
| | - Nischal Acharya
- Department of Neurological Surgery, University of California, Irvine, California, USA
| | - Chen Yi Yang
- Department of Neurological Surgery, University of California, Irvine, California, USA
| | - Yu-Po Lee
- Department of Orthopedic Surgery, University of California, Irvine, California, USA
| | - Kiarash Golshani
- Department of Neurological Surgery, University of California, Irvine, California, USA
| | - Nitin N Bhatia
- Department of Orthopedic Surgery, University of California, Irvine, California, USA
| | - Frank P K Hsu
- Department of Neurological Surgery, University of California, Irvine, California, USA
| | - Michael Y Oh
- Department of Neurological Surgery, University of California, Irvine, California, USA.
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31
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Bisht S, Laurente R, Joshi KG. Circumferential intradural meningioma of the thoracic spine: Case report and literature review. Surg Neurol Int 2021; 12:120. [PMID: 33880225 PMCID: PMC8053448 DOI: 10.25259/sni_869_2020] [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: 12/03/2020] [Accepted: 01/28/2021] [Indexed: 11/10/2022] Open
Abstract
Background: Meningiomas are common intradural extramedullary spinal tumors with a predilection for the thoracic spine. They are mostly benign (90%), with only a few showing malignant potential. However, circumferential intradural meningiomas surrounding the spinal cord are exceptionally rare. Here, we present a 40-year-old patient with a T6-T7 circumferential lesion who underwent surgery. In addition, we reviewed three similar cases previously reported in the literature. Case Description: A 40-year-old female presented with paraparesis. Imaging demonstrated a T6-T7 thoracic circumferential intradural lesion, considered to most likely be a meningioma. At surgery, the posterolateral portion of the tumor was removed, but there was residual ventral disease. The tumor recurred several years later, and was again partially removed, now leaving her with a residual neurological deficit. Three similar cases of circumferential meningiomas, one cervical and two thoracic, were reported from the literature. Conclusion: Circumferential meningiomas pose unique and significant surgical challenges, particularly since resection of the posterolateral components is feasible, but some tumor may have to be left ventrally to avoid injury to the anterior spinal artery, that may recur.
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Affiliation(s)
- Sneha Bisht
- Department of Neurosurgery, Kathmandu University, Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal
| | - Raphael Laurente
- Department of Neurosurgery, Salford Royal NHS Foundation Trust, Salford, United Kingdom
| | - K George Joshi
- Department of Neurosurgery, Salford Royal NHS Foundation Trust, Salford, United Kingdom
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Sadrameli SS, Chan TM, Lee JJ, Desai VR, Holman PJ. Resection of Spinal Meningioma Using Ultrasonic BoneScalpel Microshaver: Cases, Technique, and Review of the Literature. Oper Neurosurg (Hagerstown) 2020; 19:715-720. [PMID: 32726428 DOI: 10.1093/ons/opaa223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 05/03/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Meningiomas of the spinal canal comprise up to 40% of all spinal tumors. The standard management of these tumors is gross total resection. The outcome and extent of resection depends on location, size, patient's neurologic status, and experience of the surgeon. Heavily calcified spinal meningiomas often pose a challenge for achieving gross total resection without cord injury. OBJECTIVE To report our experience with the BoneScalpel Micro-shaver to resect heavily calcified areas of spinal meningiomas adherent to the spinal cord without significant cord manipulation, achieving gross total resection and outstanding clinical results. METHODS Seventy-nine and 82-yr-old females presented with progressive leg weakness, paresthesias, and gait instability. Magnetic resonance imaging of the thoracic spine showed a homogenous enhancing intradural extramedullary mass with mass effect on the spinal cord. Midline bilateral laminectomy was performed, and the dura was open in midline. The lateral portion of the tumor away from the spinal cord was resected with Cavitron Ultrasonic Surgical Aspirator while the BoneScalpel Micro-shaver (power level 5 and 30% irrigation) was brought into the field for the calcified portion of the tumor adherent to the spinal cord. RESULTS Gross total resection was achieved for both cases. At the 2-wk postoperative visit, both patients reported complete recovery of their leg weakness with significant improvement in paresthesias and ataxia. CONCLUSION The ultrasonic osteotome equipped with a microhook tip appears to be a safe surgical instrument allowing for effective resection of spinal meningiomas or other heavily calcified spinal masses not easily removed by usual surgical instrumentation.
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Affiliation(s)
- Saeed Sam Sadrameli
- Department of Neurosurgery, Houston Methodist Neurological Institute, Houston, Texas
| | - Tiffany Michelle Chan
- Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Jonathan Jinhee Lee
- Department of Neurosurgery, Houston Methodist Neurological Institute, Houston, Texas
| | - Virendra R Desai
- Department of Neurosurgery, Houston Methodist Neurological Institute, Houston, Texas
| | - Paul J Holman
- Department of Neurosurgery, Houston Methodist Neurological Institute, Houston, Texas
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Abstract
Context: Approximately 25% of all primary spinal cord tumors are meningiomas, and 80% of these tumors occur in the thoracic region. Few meningiomas of the lumbar spine have been presented. Extracranial metastasis of meningioma occurs extremely rare, only in about 0.1% of meningiomas. Even metastasis, the sites are seldom seen in deep soft tissue. We reported a woman original meningioma in the lumbar spine with distal deep neck metastasis. Findings: A 59-year-old patient suffered from severe right drop foot, numbness, and radicular pain for the previous 6 months. Computed tomography (CT) disclosed a huge, macrolobulated retroperitoneal soft-tissue lesion with a size of 14.9 × 10.8 × 17.7 cm. Magnetic resonance imaging (MRI) further revealed a solid spinal intracanal tumor with moderate enhancement involving the right paraspinal region at the L2∼L5 level and the right iliac fossa. A meningioma was diagnosed with histological proof. Four months later, another metastatic meningioma in her left neck. She was managed conservatively without neurologic dysfunction. Conclusions: To the best of our knowledge, such a large meningioma of the lumbar spine has not previously been reported in the literature. In this study, we demonstrated a rare spinal meningioma located in the lumbar spine primarily with secondary soft tissue metastasis.
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Affiliation(s)
- Chih-Wei Sung
- Department of Emergency Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
| | - Kevin Li-Chun Hsieh
- Department of Medical Imaging, Taipei Medical University Hospital, Taipei, Taiwan,Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yi-Jie Kuo
- Department of Orthopedic Surgery, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan,Department of Orthopedic Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan,Correspondence to: Yi-Jie Kuo, Department of Orthopedic Surgery, Wan Fang Hospital, Taipei Medical University, 111 Xinglong Rd., Sec. 3, Taipei11696, Taiwan.
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Ghaffari-Rafi A, Mehdizadeh R, Ghaffari-Rafi S, Leon-Rojas J. Demographic and socioeconomic disparities of benign and malignant spinal meningiomas in the United States. Neurochirurgie 2020; 67:112-118. [PMID: 33068594 DOI: 10.1016/j.neuchi.2020.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 06/23/2020] [Accepted: 09/02/2020] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Spinal meningiomas constitute the majority of primary spinal neoplasms, yet their pathogenesis remains elusive. By investigating the distribution of these tumors across sociodemographic variables can provide direction in etiology elucidation and healthcare disparity identification. METHODS To investigate benign and malignant spinal meningioma incidences (per 100,000) with respect to sex, age, income, residence, and race/ethnicity, we queried the largest American administrative dataset (1997-2016), the National (Nationwide) Inpatient Sample (NIS), which surveys 20% of United States (US) discharges. RESULTS Annual national incidence was 0.62 for benign tumors and 0.056 for malignant. For benign meningiomas, females had an incidence of 0.81, larger (P=0.000004) than males at 0.40; yet for malignant meningiomas, males had a larger (P=0.006) incidence at 0.062 than females at 0.053. Amongst age groups, peak incidence was largest for those 65-84 years old (2.03) in the benign group, but 45-64 years old (0.083) for the malignant group. For benign and malignant meningiomas respectively, individuals with middle/high income had an incidence of 0.67 and 0.060, larger (P=0.000008; P=0.04) than the 0.48 and 0.046 of low income patients. Incidences were statistically similar (P=0.2) across patient residence communities. Examining race/ethnicity (P=0.000003) for benign meningiomas, incidences for Whites, Asian/Pacific Islanders, Hispanics, and Blacks were as follows, respectively: 0.83, 0.42, 0.28, 0.15. CONCLUSIONS Across sociodemographic strata, healthcare inequalities were identified with regards to spinal meningiomas. For benign spinal meningiomas, incidence was greatest for patients who were female, 65-84 years old, middle/high income, living in rural communities, White, and Asian/Pacific Islander. Meanwhile, for malignant spinal meningiomas incidence was greatest for males, those 45-65 years old, and middle/high income.
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Affiliation(s)
- Arash Ghaffari-Rafi
- University of Hawai'i at Mānoa, John A. Burns School of Medicine, 651 Ilalo St, Honolulu, 96813, HI, USA.
| | - Rana Mehdizadeh
- University of Queensland, Faculty of Medicine, Brisbane, Australia
| | | | - Jose Leon-Rojas
- Universidad Internacional del Ecuador Escuela de Medicina, Quito, Ecuador
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Spinal meningiomas: Treatment outcome and long-term follow-up. Clin Neurol Neurosurg 2020; 198:106238. [PMID: 33096449 DOI: 10.1016/j.clineuro.2020.106238] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/31/2020] [Accepted: 09/12/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Spinal 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. OBJECTIVE To 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. METHODS A large single center retrospective analysis of 166 consecutive spinal meningioma patients during a 29-year period (1989-2018). RESULTS Female 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. CONCLUSIONS The 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.
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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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Abstract
Spinal meningiomas are typically slow growing, benign lesions with the potential to cause significant morbidity if untreated. Their incidence is approximately 3 per 100,000 and they are more common in women than in men. Surgical resection has a relatively low complication rate and the potential for very favorable outcomes. Surgery remains the mainstay of treatment with radiation reserved for those who cannot tolerate the procedure or for recurrent disease. We describe the epidemiology, presentation, and treatment options for spinal meningiomas here as well as provide an example case.
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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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Yamaguchi S, Menezes AH, Shimizu K, Woodroffe RW, Helland LC, Hitchon PW, Howard MA. Differences and characteristics of symptoms by tumor location, size, and degree of spinal cord compression: a retrospective study on 53 surgically treated, symptomatic spinal meningiomas. J Neurosurg Spine 2020; 32:931-940. [PMID: 32005026 DOI: 10.3171/2019.12.spine191237] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 12/02/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The differences in symptoms of spinal meningiomas have rarely been discussed from the perspective of tumor characteristics. The main purpose of this paper was to define the differences, if any, in symptoms in patients with spinal meningiomas with respect to tumor size, location, and degree of spinal cord compression. The authors also sought the threshold of spinal cord compression that causes motor weakness. METHODS The authors conducted a retrospective study of 53 cases of spinal meningiomas that were surgically treated from 2013 to 2018. Symptoms related to the tumor were classified as motor weakness, sensory disturbance, pain, and bowel/bladder dysfunction. Based on MR images, tumor location was classified by spinal level and by its attachment to the dura mater. Tumor dimensions were also measured. Occupation ratios of the tumors to the spinal canal and degree of spinal cord flattening were sought from the axial MR images that showed the highest degree of spinal cord compression. RESULTS Motor weakness and sensory disturbance were significantly more common in thoracic spine meningiomas than in cervical spine meningiomas (p < 0.001 and p = 0.013, respectively), while pain was more common in meningiomas at the craniovertebral junction (p < 0.001). The attachment, height, width, depth, and volume of the tumor showed no significant difference irrespective of the presence or absence of each symptom. In cases of motor weakness and sensory disturbance, occupation ratios and spinal cord flattening ratios were significantly larger. However, these ratios were significantly smaller in the presence of pain. Multivariate logistic regression analysis revealed that occupation ratio independently contributed to motor weakness (OR 1.14, p = 0.035) and pain (OR 0.925, p = 0.034). Receiver operating characteristic curve analysis suggested that occupation ratio with a value of 63.678% is the threshold for the tumor to cause motor weakness. CONCLUSIONS The study showed the difference in clinical presentation of spinal meningiomas by spinal level, occupation ratio, and spinal cord flattening ratio. An occupation ratio of approximately 64% could be utilized as the threshold value of tumor growth to cause motor weakness. Tumor growth in the cervical spine might cause pain symptoms before causing motor weakness. The relationship between the tumor and its symptomatology should be discussed with respect to tumor size relative to the surrounding spinal canal.
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Affiliation(s)
- Satoshi Yamaguchi
- 1Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa; and
| | - Arnold H Menezes
- 1Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa; and
| | - Kiyoharu Shimizu
- 2Department of Neurosurgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Royce W Woodroffe
- 1Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa; and
| | - Logan C Helland
- 1Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa; and
| | - Patrick W Hitchon
- 1Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa; and
| | - Matthew A Howard
- 1Department of Neurosurgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa; and
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Clinical features and surgical outcomes of high-grade spinal meningiomas: Report of 19 cases and literature review. J Clin Neurosci 2020; 72:264-269. [PMID: 31983641 DOI: 10.1016/j.jocn.2019.11.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 10/08/2019] [Accepted: 11/19/2019] [Indexed: 11/22/2022]
Abstract
High-grade spinal meningiomas (SMs) are extremely rare lesions. The true incidence, clinical features and prognosis of SMs are still unclear. To elucidate this information by using institutional data and to provide an updated review of the literature. Nineteen consecutive patients harboring 20 high-grade SMs were identified, including 15 (78.9%) female patients, with a mean age of 37.8 ± 14.9 years. The 20 tumors were most frequently located in the lumbar and lumbosacral segment (n = 6, 30.0%), followed by the cervical segment (n = 5, 25.0%), thoracolumbar junction (n = 4, 20.0%), thoracic (n = 3, 15.0%) and cervicothoracic junction (n = 2, 10.0%). The mean number of affected spinal levels was 2 ± 1. Simpson grade II and III resection were achieved for sixteen (80.0%) and four (20.0%) tumors, respectively. During a mean follow-up of 79.6 ± 39.9 months, three tumors (15.0%) recurred. Fourteen patients (73.7%) achieved excellent outcomes, three (15.7%) remained stable, one (5.3%) deteriorated, and one (5.3%) died. High-grade SMs are rare entities which consist of 5.7% SM. These lesions tend to affect young patients, with atypical meningioma being the most common pathological subtype. In our study, surgery was an effective means of treatment. Close observation is warranted after surgery because of the high recurrence rate. Recurrent patients can still benefit from a second surgery.
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Eroglu U, Bahadır B, Tomlinson SB, Ugur HC, Sayaci EY, Attar A, Caglar YS, Cohen Gadol AA. Microsurgical Management of Ventral Intradural-Extramedullary Cervical Meningiomas: Technical Considerations and Outcomes. World Neurosurg 2020; 135:e748-e753. [PMID: 31901496 DOI: 10.1016/j.wneu.2019.12.145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 12/21/2019] [Accepted: 12/23/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Cervical meningiomas are uncommon intradural-extramedullary tumors that have a tendency to be situated anterior to the spinal cord. The optimal surgical corridor to reach purely ventral cervical meningiomas has not been established. This article presents a series of patients with ventral cervical meningiomas treated via 1 of 2 microneurosurgical approaches: the anterior approach with corpectomy and fusion or the posterolateral approach. METHODS Eight patients who underwent surgical resection of solitary, histopathologically confirmed, intradural-extramedullary cervical meningiomas of purely ventral location were retrospectively examined. Preoperative and postoperative Nurick scores quantified the degree of ambulatory function. Patients were followed for an average of 2.1 years after surgery. Postoperative imaging was performed to determine the extent of resection and to assess for tumor recurrence. RESULTS Two patients with lower cervical meningiomas underwent resection via an anterior approach with single-level corpectomy and fusion. Six patients were treated via a posterolateral approach including ipsilateral hemilaminectomy and partial facetectomy without fusion. No intraoperative or postoperative complications were observed. Gross total resection was achieved in 8 of 8 patients, although 1 patient exhibited tumor recurrence. Improvement in ambulatory function was observed in all patients. CONCLUSIONS Purely ventral cervical meningiomas are uncommon and pose unique technical challenges for neurosurgeons. We document favorable outcomes from 2 cases of lower cervical meningioma treated via an anterior approach and 6 cases of upper cervical tumors treated via a posterolateral approach. This series demonstrates operative considerations for effectively managing ventral cervical meningiomas.
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Affiliation(s)
- Umit Eroglu
- Department of Neurosurgery, School of Medicine, Ankara University, Yenimahalle, Ankara, Turkey
| | | | - Samuel B Tomlinson
- School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, New York, USA
| | - Hasan Caglar Ugur
- Department of Neurosurgery, School of Medicine, Ankara University, Yenimahalle, Ankara, Turkey
| | - Emre Yagiz Sayaci
- Department of Neurosurgery, School of Medicine, Ankara University, Yenimahalle, Ankara, Turkey
| | - Ayhan Attar
- Department of Neurosurgery, School of Medicine, Ankara University, Yenimahalle, Ankara, Turkey
| | - Yusuf Sukru Caglar
- Department of Neurosurgery, School of Medicine, Ankara University, Yenimahalle, Ankara, Turkey
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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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Jamilson Araújo Pereira B, Nogueira de Almeida A, Silva Paiva W, Henrique Pires de Aguiar P, Jacobsen Teixeira M, Kazue Nagahashi Marie S. Neuro-oncological features of spinal meningiomas: Systematic review. Neurochirurgie 2019; 66:41-44. [PMID: 31672597 DOI: 10.1016/j.neuchi.2019.09.027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 08/18/2019] [Accepted: 09/03/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE Review the published data on spinal meningioma (SM) to create a more comprehensive picture of its natural history. METHODS A review of the published SM literature was carried out through a Medline search up to December 2018. The search using the keyword "spinal meningiomas" returned 248 papers and the parameters analyzed in our present study were examined in those publications. Papers without a detailed description of clinical findings, neuroimaging confirmation of the spinal tumor, minimum follow-up of 5 years, or a clear description of the clinical findings were excluded. RESULTS In the 24 manuscripts reviewed, 1811 (1450 females/361 males) patients with SM were analyzed. The thoracic spine (1181-64.6%) and cervical spine (394-22.7%) were the more prevalent levels. The psammomatous (27.8%) and meningothelial variants (25.2%) were the most prevalent histopathological subtypes. Gross total resection (Simpson I and II) was achieved in 94.5% of cases and subtotal resection (Simpson III or more) in 5.5%. The tumor recurrence rate was 4.4%, and the mortality rate related to surgery or disease progression was 3%. CONCLUSION WHO grade I predominance was observed among spinal meningiomas, analogous to intracranial meningiomas. SMs predominated in the thoracic spine. Surgery with gross total resection was achieved in the vast majority of cases, resulting in low recurrence and mortality rates.
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Affiliation(s)
- B Jamilson Araújo Pereira
- Departamento de Neurologia da Faculdade de Medicina da Universidade de São Paulo, Rua Martiniano de Carvalho, 669, Edifício Paulista Paradise Life, Apto 1105, Brasil.
| | - A Nogueira de Almeida
- Divisão de Neurocirurgia Funcional IPQ. Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brasil
| | - W Silva Paiva
- Departamento de Neurologia da Faculdade de Medicina da Universidade de São Paulo, Rua Martiniano de Carvalho, 669, Edifício Paulista Paradise Life, Apto 1105, Brasil
| | - P Henrique Pires de Aguiar
- Departamento de Neurologia da Faculdade de Medicina da Universidade de São Paulo, Rua Martiniano de Carvalho, 669, Edifício Paulista Paradise Life, Apto 1105, Brasil
| | - M Jacobsen Teixeira
- Departamento de Neurologia da Faculdade de Medicina da Universidade de São Paulo, Rua Martiniano de Carvalho, 669, Edifício Paulista Paradise Life, Apto 1105, Brasil
| | - S Kazue Nagahashi Marie
- Departamento de Neurologia da Faculdade de Medicina da Universidade de São Paulo, Rua Martiniano de Carvalho, 669, Edifício Paulista Paradise Life, Apto 1105, Brasil
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Survival in Patients with High-Grade Spinal Meningioma: An Analysis of the National Cancer Database. World Neurosurg 2019; 129:e749-e753. [DOI: 10.1016/j.wneu.2019.06.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 06/04/2019] [Accepted: 06/05/2019] [Indexed: 11/23/2022]
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Maiuri F, Del Basso De Caro M, de Divitiis O, Guadagno E, Mariniello G. Recurrence of spinal meningiomas: analysis of the risk factors. Br J Neurosurg 2019; 34:569-574. [PMID: 31290345 DOI: 10.1080/02688697.2019.1638886] [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] [Indexed: 10/26/2022]
Abstract
Objective: Spinal meningiomas are slow-growing tumors with low recurrence rate after complete resection. The aim of this study is to investigate the risk factors correlated to the recurrence.Material and Methods: Six patients with spinal WHO grade I meningiomas which recurred after complete resection were reviewed and compared to 50 patients with no recurrence; the data were also compared with those of 50 intracranial meningiomas which recurred and 50 which did not recur after complete resection. The investigated factors included age and sex, tumor location and size, type of arachnoid interface, entity of resection (Simpson I or II), tumor consistency and vascularity, histological type, Ki-67 MIB-1, progesterone receptor (PR) and estrogen receptor (ER) expression. The data were statistically analyzed with the Kaplan-Meier method.Results: The statistical analysis showed that the presence of arachnoidal invasion (p = 0.023) and higher Ki-67 LI (p < 0.0001) were the only two significant risk factors for recurrence for both spinal and intracranial meningiomas. Large tumor size (p = 0.012), Simpson grade II resection (p = 0.03) and the absence of PR expression (p < 0.0001) were significant risk factors for recurrence of intracranial but not spinal meningiomas. Finally, age and sex, tumor location, consistency and vascularity, histological type, and ER expression were not correlated to recurrence for both localizations.Conclusions: The proliferation index Ki-67 and the arachnoid invasion are the risk factors for recurrence of spinal meningiomas, whereas tumor size, dural resection and PR expression are not significant. The small tumor size and the limited dural invasion may contribute to explain the lower recurrence rate.
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Affiliation(s)
- Francesco Maiuri
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, University of Naples "Federico II", Naples, Italy
| | - Marialaura Del Basso De Caro
- Department of Advanced Biomedical Sciences, Section of Pathology, University of Naples "Federico II", Naples, Italy
| | - Oreste de Divitiis
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, University of Naples "Federico II", Naples, Italy
| | - Elia Guadagno
- Department of Advanced Biomedical Sciences, Section of Pathology, University of Naples "Federico II", Naples, Italy
| | - Giuseppe Mariniello
- Department of Neurosciences and Reproductive and Odontostomatological Sciences, Division of Neurosurgery, University of Naples "Federico II", Naples, Italy
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Phan K, Vig KS, Ho YT, Hussain AK, Di Capua J, Kim JS, White SJW, Lee NJ, Kothari P, Cho SK. Age Is a Risk Factor for Postoperative Complications Following Excisional Laminectomy for Intradural Extramedullary Spinal Tumors. Global Spine J 2019; 9:126-132. [PMID: 30984489 PMCID: PMC6448195 DOI: 10.1177/2192568218754512] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
STUDY DESIGN Retrospective analysis. OBJECTIVE The incidence of intradural extramedullary (IDEM) spinal tumors is increasing. Excisional laminectomy for removal and decompression is the standard of care, but complications associated with patient age are unreported in the literature. Our objective is to identify if age is a risk factor for postoperative complications after excisional laminectomy of IDEM spinal tumors. METHODS A retrospective analysis was performed on the 2011 to 2014 ACS-NSQIP (American College of Surgeons National Surgical Quality Improvement Program) database for patients undergoing excisional laminectomy of IDEM spinal tumors. Age groups were determined by interquartile analysis. Chi-squared tests, t tests, and multivariate logistic regression models were employed to identify independent risk factors. Institutional review board approval was not needed. RESULTS A total of 1368 patients met the inclusion criteria for the study. Group 1 (age ≤ 44) contained 372 patients, group 2 (age 45-54) contained 314 patients, group 3 (age 55-66) contained 364 patients, and group 4 (age > 66) contained 318 patients. The univariate analysis showed that mortality and unplanned readmission were highest among patients in group 4 (1.26%, P = .011, and 10.00%, P = .039, respectively). Postoperative wound complications were highest among patients in group 1 (2.15%, P = .009), and postoperative venous thromboembolism and cardiac complications were highest among patients in group 3 (4.4%, P = .007, and 1.10%, P = .032, respectively). Multivariate logistic regression revealed that elderly age was an independent risk factor for postoperative venous thromboembolism (group 3 vs group 1; odds ratio = 6.739, confidence interval = 1.522-29.831, P = .012). CONCLUSIONS This analysis revealed that increased age is an independent risk factor for postoperative venous thromboembolism in patients undergoing excisional laminectomy for IDEM spinal tumors.
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Affiliation(s)
- Kevin Phan
- Prince of Wales Private Hospital, Sydney, New South Wales, Australia
- University of New South Wales, Sydney, New South Wales, Australia
| | | | - Yam Ting Ho
- Prince of Wales Private Hospital, Sydney, New South Wales, Australia
| | | | - John Di Capua
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Jun S. Kim
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Nathan J. Lee
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Parth Kothari
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Samuel K. Cho
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Onken J, Obermüller K, Staub-Bartelt F, Meyer B, Vajkoczy P, Wostrack M. Surgical management of spinal meningiomas: focus on unilateral posterior approach and anterior localization. J Neurosurg Spine 2019; 30:308-313. [DOI: 10.3171/2018.8.spine18198] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Accepted: 08/06/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVESpinal meningiomas (sMNGs) are relatively rare in comparison to intracranial MNGs. sMNGs localized anterior to the denticulate ligament (aMNGs) represent a surgically challenging subgroup. A high perioperative complication rate due to the need for complex surgical approaches has been described. In the present study, the authors report on their surgical experience that involves two institutions in which 207 patients underwent surgery for sMNGs. Special focus was placed on patients with aMNGs that were treated via a unilateral posterior approach (ULPA).METHODSBetween 2005 and 2017, 207 patients underwent resection of sMNGs at one of two institutions. The following characteristics were assessed: tumor size and localization, surgical approach, duration of surgery, grade of resection, peri- and postoperative complication rates, and neurological outcome. Data were compared between the subgroups of patients according to the lesion’s relationship to the denticulate ligament and to surgical approach.RESULTSThe authors identified 48 patients with aMNGs, 86 patients with lateral MNGs, and 76 patients with posterior MNGs (pMNGs). Overall, 66.6% of aMNGs and 64% of pMNGs were reached via a ULPA. aMNGs that were approached via a ULPA showed reduced duration of surgery (131 vs 224 minutes, p < 0.0001) and had surgical complication rates and neurological outcomes comparable to those of lesions that were approached via a bilateral approach. No significant differences in complication rate, outcomes, and extent of resection were seen between aMNGs and pMNGs.CONCLUSIONSThe duration of surgery, extent of resection, and outcomes are comparable between aMNGs and pMNGs when removed via a ULPA. Thus, ULPA represents a safe route to achieve a gross-total resection, even in cases of aMNG.
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Affiliation(s)
- Julia Onken
- 1Department of Neurosurgery, Charité—Universitätsmedizin Berlin
- 2Berlin School of Integrative Oncology (BSIO), Berlin; and
| | - Kathrin Obermüller
- 3Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Germany
| | | | - Bernhard Meyer
- 3Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Germany
| | - Peter Vajkoczy
- 1Department of Neurosurgery, Charité—Universitätsmedizin Berlin
| | - Maria Wostrack
- 3Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Germany
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Treatment outcomes of 17 patients with atypical spinal meningioma, including 4 with metastases: a retrospective observational study. Spine J 2019; 19:276-284. [PMID: 29906618 DOI: 10.1016/j.spinee.2018.06.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 06/05/2018] [Accepted: 06/05/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Because of the scarcity of atypical spinal meningioma, there is a lack of research on this type of tumor or its associated metastases. PURPOSE The aim of this study was to investigate the biological behavior of atypical spinal meningioma and identify its prognostic factors by reviewing surgical and clinical outcomes of patients with these tumors. STUDY DESIGN A retrospective chart review was performed. PATIENT SAMPLE We retrospectively reviewed the data from all patients who underwent spinal cord tumor excision between 1994 and 2017. Seventeen patients were pathologically proven to have atypical spinal meningioma. OUTCOME MEASURES We examined patients' neurologic status by determining their Nurick scores before and after surgery. Moreover, imaging studies, laboratory data, and the employed surgical method were analyzed retrospectively, as was the Ki-67 index and prognosis following postoperative radiation therapy. METHODS The ranges, locations, and pathologic diagnoses of the tumors were extracted from the radiological and pathological records of each patient. The extent of surgery and progression of disease were confirmed using postoperative enhanced magnetic resonance imaging. Patients were divided into two atypical spinal meningioma groups: primary and metastatic. The demographics, age, sex, presenting symptom duration, tumor location, Simpson resection grade, Ki-67, radiotherapy, recurrence, overall survival, and progression-free survival of patients in both groups were compared. RESULTS Seventeen patients were included in the analysis, of whom 12 (70%), 4 (24%), and 1 (6%) had tumors in the thoracic, cervical, and sacral regions, respectively. Complete and subtotal resections were achieved in 15 (88%) and 2 (12%) patients, respectively. Overall and progression-free survival rates in patients who underwent complete resection were longer than those in patients who underwent subtotal resection (p<.001). Four patients (24%) had metastatic meningiomas in the brain, among whom three were administered adjuvant radiotherapy after surgery. Two patients with intramedullary atypical spinal meningioma had metastatic tumors and experienced poorer prognoses. The 5-year overall and progression-free survival rates were 84.4% and 85.2%, respectively. The Simpson resection grade, Ki-67 index, and preoperative neurologic status were found to be important prognostic factors on univariate Cox regression analysis (p<.05). CONCLUSIONS Complete resection should be considered as a primary treatment modality for individuals with atypical spinal meningioma. If subtotal resection is performed, adjuvant therapy can be administered.
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Mubeen B, Makhdoomi R, Nayil K, Rafiq D, Kirmani A, Salim O, Mustafa F, Aimen A, Khursheed S, Bashir S, Shafi S, Ramzan A. Clinicopathological Characteristics of Meningiomas: Experience from a Tertiary Care Hospital in the Kashmir Valley. Asian J Neurosurg 2019; 14:41-46. [PMID: 30937006 PMCID: PMC6417349 DOI: 10.4103/ajns.ajns_228_16] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background: Meningiomas comprise 15%–20% of all primary intracranial tumors. They are generally benign tumors, and most patients are cured after surgery and remain free of recurrence. However, some tumors behave in an aggressive manner, and patients develop local recurrence or metastasis. Overall prognosis is good. Patients and Methods: This is an 11-year retrospective study conducted in the Departments of Pathology and Neurosurgery at Sheri-I-Kashmir Institute of Medical Sciences, Kashmir, India. Besides the demographic profile, the parameters analyzed were location of tumor on imaging, histopathological subtype, and grade of tumor according to the 2007 WHO classification and recurrence at follow-up. Results: A total of 254 patients were included in our study, of which 205 (80.7%) were brain meningiomas and 49 (19.3%) were spinal, with an overall female: male ratio of 2:1. Female: male ratio was more in spinal meningiomas, 15.3:1. Most of our patients were in the 4–6th decade of life with a mean age of 48 years (range: 5–73 years). Meningothelial meningioma was the most common histological type. Of ten patients who showed recurrence, seven cases showed only recurrence, but no progression to higher grade and three cases showed recurrence with progression by one WHO-grade. We also noticed that recurrence was higher in Simpson Grades II and III. Conclusion: Meningiomas are common in females and most of the meningiomas do well after surgery. The recurrence rate was 3.93% in our study and Simpson grade of tumor excision and histopathological grade contribute significantly to the recurrence of the tumor.
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Affiliation(s)
- Basharat Mubeen
- Department of Pathology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Rumana Makhdoomi
- Department of Pathology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Khursheed Nayil
- Department of Neurosurgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Danish Rafiq
- Department of Pathology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Altaf Kirmani
- Department of Neurosurgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Othman Salim
- Department of Pathology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Farhat Mustafa
- Department of Pathology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Aifa Aimen
- Department of Pathology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Sumat Khursheed
- Department of Pathology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Shazia Bashir
- Department of Pathology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Saba Shafi
- Department of Pathology, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
| | - Altaf Ramzan
- Department of Neurosurgery, Sher-I-Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
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Li J, Zhang S, Wang Q, Cheng J, Deng X, Wang Y, Hui X. Spinal Clear Cell Meningioma: Clinical Study with Long-Term Follow-Up in 12 Patients. World Neurosurg 2018; 122:e415-e426. [PMID: 30342264 DOI: 10.1016/j.wneu.2018.10.064] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 10/06/2018] [Accepted: 10/08/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Clear cell meningioma (CCM) is a rare histologic subtype of meningioma. The features of CCMs have commonly been based on intracranial cases. However, CCMs in the spinal cord are even rarer, and their natural history, management, and prognosis remain ill-defined. METHODS From January 2006 to January 2018, 12 patients with spinal CCM were treated in our hospital. The clinical features, radiologic findings, diagnosis, treatment, and outcome of these patients were analyzed retrospectively. Additionally, we performed a review of the reported data on spinal CCMs. RESULTS CCMs accounted for 2.8% of all the spinal meningiomas treated in our hospital. The most common localization of this disease was the lumbar region (7 of 12). The mean age at diagnosis was significantly younger than that of patients with spinal meningiomas (28.8 ± 13.4 years vs. 54.0 ± 14.4 years). During the follow-up period, 5 patients (41.7%) experienced tumor recurrence. Kaplan-Meier analysis showed that younger patients had a significantly shorter progression-free survival time than older patients. The review of the reported data showed that 55 cases of spinal CCMs had been reported. Nineteen patients (38.0%) had developed local recurrence, with a 5-year progression-free survival rate of 33.3%. CONCLUSIONS Spinal CCMs are extremely rare tumors with a predilection to affect younger patients and have a high recurrence rate. Although gross total resection is considered to be the optimal treatment, radiotherapy could be considered for patients who had undergone subtotal resection or for younger patients, regardless of the extent of removal. Close follow-up of the entire neuraxis for years is crucial.
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Affiliation(s)
- Jiuhong Li
- Department of Neurosurgery, West China Hospital of Sichuan University, Sichuan, China
| | - Si Zhang
- Department of Neurosurgery, West China Hospital of Sichuan University, Sichuan, China
| | - Qiguang Wang
- Department of Neurosurgery, West China Hospital of Sichuan University, Sichuan, China
| | - Jian Cheng
- Department of Neurosurgery, West China Hospital of Sichuan University, Sichuan, China
| | - Xueyun Deng
- Department of Neurosurgery, Nanchong Central Hospital, The Second Clinical Medical College of North Sichuan Medical College, Nanchong, China
| | - Yanchao Wang
- Department of Neurosurgery, West China Hospital of Sichuan University, Sichuan, China
| | - Xuhui Hui
- Department of Neurosurgery, West China Hospital of Sichuan University, Sichuan, China.
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