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

Raco, Antonino; Pesce, Alessandro; Toccaceli, Giada; Domenicucci, Maurizio; Miscusi, Massimo; Delfini, Roberto

doi:10.1093/neuros/nyw092

Cited by 71 publications

(61 citation statements)

References 25 publications

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“…24 Intraoperative spinal navigation with MRI holds promise in aiding tumor localization and thereby minimizing exposure and bony removal, as well as potentially obviating the need for spinal instrumentation. 18,25,26 In this case, our first experience with the technology, the aim was to establish technical feasibility, and in this regard, the case was successful. We found adequate accuracy at the level of the bone, dura, and the tumor-parenchyma interface.…”

Section: Discussionmentioning

confidence: 83%

Novel Technique of Coregistered Intraoperative Computed Tomography and Preoperative Magnetic Resonance Imaging and Diffusion Tensor Imaging Navigation in Spinal Cord Tumor Resection

Scullen

Riffle

Koga

et al. 2019

TOJ

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Background: Intradural spinal tumors are surgically challenging lesions, and intraoperative spinal navigation offers clear potential assistance. While intraoperative computed tomography (iCT) of bony anatomy is routinely performed, coregistration with magnetic resonance imaging (MRI) and diffusion tensor imaging (DTI) to facilitate intradural spinal tumor resection is not widely described. We present 2 cases in which iCT was coregistered with MRI and DTI for navigational guidance in the resection of intradural spinal tumors to assess technical feasibility and surgical efficacy. Case Series: Navigation using coregistered iCT/MRI was used in the resection of one extramedullary and one intramedullary cervicomedullary tumor. The iCT was obtained following open midline exposure of bony anatomy. The images were then coregistered with preoperative MRI sequences to allow for optical tracking navigation via an optical tracking station (Brainlab). For the intramedullary tumor, preoperative DTI sequences were also coregistered for enhanced identification of relevant anatomy. Navigational accuracy for all cases was confirmed to be acceptable at the level of the posterior bony elements, the dura, and the tumor-parenchyma interface. Conclusion: The coregistration of preoperative MRI sequences and iCT images allowed for meaningfully enhanced navigation during resection. In the case involving the intramedullary cervicomedullary tumor with marked distortion of longitudinal tracts, iCT/DTI navigation allowed for accurate visualization of critical structures and facilitated delineation of tumor margins that otherwise would have been difficult. The use of combined iCT and preoperative MRI/DTI neuronavigational guidance is an effective approach in the resection of intradural extramedullary and intramedullary spinal cord tumors.

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Section: Discussionmentioning

confidence: 83%

Novel Technique of Coregistered Intraoperative Computed Tomography and Preoperative Magnetic Resonance Imaging and Diffusion Tensor Imaging Navigation in Spinal Cord Tumor Resection

Scullen

Riffle

Koga

et al. 2019

TOJ

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“…La RM es el instrumento diagnóstico de elección que permite obtener datos necesarios para localizar la lesión y planificar el abordaje quirúrgico [15][16][17] . La mayor complejidad quirúrgica se da en lesiones extensas, calcificadas, con inserción predominantemente ventral, con invasión pial o de estructuras vasculares adyacentes 6,13,14 .…”

Section: Discussionunclassified

“…Los factores pronósticos de mala evolución postoperatoria reportados son los mayores déficits y la mayor duración de los síntomas preoperatorios 6 . Distintos autores 6,18 sugieren que cuanto mejor es el estado preoperatorio mayores son las chances de mejora postoperatoria. También afirman que las resecciones Simpson 4 predominaron en lesiones con implantes ventrales debido a la mayor dificultad quirúrgica.…”

Section: Discussionunclassified

Tratamiento Quirúrgico de los Meningiomas Espinales

Villanueva¹,

Santamaria²,

Villalonga³

et al. 2018

jbnc

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Objetivo: Presentar nuestra experiencia en el tratamiento quirúrgico de los meningiomas espinales. Material y métodos: Estudio descriptivo retrospectivo que incluye a 24 pacientes operados de meningiomas espinales durante el período Julio de 2009 a Diciembre de 2016. Se analizaron datos epidemiológicos, antecedentes personales, sintomatología preoperatoria, características radiológicas, hallazgos intraoperatorios, grado de resección, descripción histológica y evolución post operatoria. Resultados: Se operaron 24 pacientes siendo 83% de sexo femenino. En cuanto a la localización, 79% fueron dorsales, 17% cervicales y 4% lumbares. La anatomía patológica reveló meningiomas grado I (OMS) en todos los casos. En el 63% se abordó la lesión por hemilaminectomía, logrando en éstas un grado de resección satisfactorio (Simpson 2). El 66% de los pacientes presentaron mejoría clínica post operatoria, 30% sin cambios significativos y solo un caso (4%) de empeoramiento. El periodo de seguimiento promedio fue de 14,9 meses. Conclusión: La cirugía continúa siendo el tratamiento de elección en los meningiomas espinales. El abordaje por hemilaminectomía es una opción útil en lesiones con base de implantación lateral. Lesiones predominantemente ventrales, con componente cálcico y alteraciones motoras preoperatorias suelen presentar mayor complejidad quirúrgica y peor evolución.

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“…[ 2 , 6 ] The improvement in microsurgical techniques, neuroimaging technologies, and rehabilitation programs has further improved postoperative outcomes. [ 1 , 8 ] However, since some patients presented late with paraplegia, it is extremely difficult to predict the prognosis.…”

Section: Introductionmentioning

confidence: 99%

Delayed recovery from paraplegia following resections of thoracic meningiomas

Ashry

Mahmoud

Gabr

2020

Surgical Neurology International

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Background: In this retrospective study, we evaluated the patterns of postoperative recovery for patients who were initially paraplegic before the excision of thoracic spine meningiomas. We also determined how the various prognostic factors impacted outcomes. Methods: Twenty patients with paraplegia underwent surgical excision of thoracic spine meningiomas at 2016– 2019. Patients’ demographics, clinical, radiological data, operative details, histopathology, and postoperative complications were recorded; patients were reassessed at 6 months and 1 year postoperatively. Results: Fourteen patients improved postoperatively, becoming, ambulatory with/without assistance; only six remained paraplegic. Poor prognostic factors for postoperative motor recovery included larger tumor size, longer duration of preoperative symptoms/paraplegia, and greater severity of sensory loss. Conclusion: For 6/20 patients with thoracic meningiomas, poor postoperative recovery of motor function correlated with larger tumor size, longer duration of preoperative symptoms/paraplegia, and more severe sensory loss.

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

Abstract: We can affirm that negative prognostic factors in our study were anterior or anterolateral axial location, prolonged presentation before diagnosis, WHO grade >I, Simpson grade resections II and III, sphincter involvement, and worse functional grade at onset.

Cited by 71 publications

References 25 publications

Novel Technique of Coregistered Intraoperative Computed Tomography and Preoperative Magnetic Resonance Imaging and Diffusion Tensor Imaging Navigation in Spinal Cord Tumor Resection

Novel Technique of Coregistered Intraoperative Computed Tomography and Preoperative Magnetic Resonance Imaging and Diffusion Tensor Imaging Navigation in Spinal Cord Tumor Resection

Tratamiento Quirúrgico de los Meningiomas Espinales

Delayed recovery from paraplegia following resections of thoracic meningiomas

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