Functional Outcome After Spinal Meningioma Surgery. A Nationwide Population-Based Study

Abstract

Objective: To describe and analysed the functional outcome (FO) after spinal meningioma (SM) surgery.Methods: We processed the système national des données de santé (SNDS) i.e. , the French national administrative medical database to retrieve appropriate cases. We analysed the International Classification of Diseases 10 codes to assess the FO. Logistic models were implemented to search for variables associated with a favourable FO i.e. , a patient being independent at home without disabling symptom.Results: A total of 2,844 patients were identified of which 79.1% were female. Median age at surgery was 66 years, interquartile range (IQR) (56–75). Ninety-five point nine percent of the SMs were removed through a posterior ± lateral approach and 0.7% need an associated stabilisation. Benign meningioma represented 92.9% and malignant 2.1%. Median follow-up was 5.5 years, IQR (2.1–8), and at data collection 9% had died. The FO was good and increased along the follow-up: 84.3% of the patients were alive and had not associated symptoms at one year, 85.9% at 2 and 86.8% at 3 years. Nonetheless, 3 years after the surgery 9.8% of the alive patients still presented at least one disabling symptom of which 2.7% motor deficit, 3.3% bladder control problem, and 2.5% gait disturbance. One point seven percent were care-provider dependent and 2.1% chair or bedfast. In the multivariable logistic regression an older age at surgery (odds ratio [OR], 0.37; 95% confidence interval [CI], 0.29–0.47, p < 0.001), a high level of comorbidities (OR, 0.71; 95% CI, 0.66–0.75, p < 0.001), and an aggressive tumor (OR, 0.49; 95% CI, 0.33–0.73; p < 0.001) were associated with a worse FO.Conclusion: FO after meningioma surgery is favourable but, may be impaired for older patients with a high level of comorbidities and aggressive tumor.

Current Knowledge on Spinal Meningiomas Epidemiology, Tumor Characteristics and Non-Surgical Treatment Options: A Systematic Review and Pooled Analysis (Part 1)

“…Three studies only including adults (>18 years) reported 28 cases among 3063 patients (0.9%) [ 4 , 55 , 56 ]. The lower percentage in these studies may indicate that a significant number of these patients are diagnosed before reaching adulthood.…”

“…Age was positively correlated to motor symptoms in three studies [ 4 , 55 , 65 ], to sensory deficits in two studies—one of which with non-significant results [ 4 , 65 ]—gait, and bladder and bowel deficits in one study [ 55 ], and to none of the symptoms in another study [ 63 ]. In one of these studies including a total of 2844 patients, the authors stated that the symptoms were more severe in the elderly population.…”

Spinal Meningioma Surgery in Octogenarians: Functional Outcomes and Complications over a 2-Year Follow-Up Period

“…It is important to highlight that no explicit analysis has been conducted for outcomes in older patients. Similarly, in another SM study based on claim data, patients aged 70 years and older were significantly burdened by higher degrees of disability than occurred in younger patients (49.6% vs. 30.5; p < 0.001) [ 23 ]. However, surgical resection of SMs resulted in substantial amelioration of patients’ functional status, although older patients require more time for recovery, which is apparently due to their clinical vignette [ 23 ].…”

“…Similarly, in another SM study based on claim data, patients aged 70 years and older were significantly burdened by higher degrees of disability than occurred in younger patients (49.6% vs. 30.5; p < 0.001) [ 23 ]. However, surgical resection of SMs resulted in substantial amelioration of patients’ functional status, although older patients require more time for recovery, which is apparently due to their clinical vignette [ 23 ]. Older age at a given level of surgery and higher rates of underlying conditions were significant risk factors for less favorable outcomes.…”

“…In concert with the above-mentioned studies, Morandi et al observed no operative mortality in patients aged ≥70 years after microsurgical resection of SMs [ 11 ]. Likewise, Champeaux-Depond et al found a very low mortality rate of 0.6% in a large cohort of 277 patients with SMs [ 23 ]. In contrast, we found higher in-hospital and 90-day mortality rates of 6.7% and 10%, respectively.…”