Management of spinal meningiomas: surgical results and a review of the literature

Abstract

ENINGIOMAS are typically benign, slowly growing tumors. Despite the fact that their histogenesis is unclear, it is thought that arachnoidal cells are the most likely origin of these lesions. 20 Meningiomas account for 13 to 19% of all intracranial tumors. 35,45 Spinal meningiomas represent 12% of all meningiomas 31 and 25 to 45% of intradural spine tumors. 14 Spinal meningiomas lead to chronic spinal cord compression and myelopathy. Treatment is predominantly surgical. Previously published data indicate mostly favorable outcomes; however, progressive spinal cord compression due to a spinal meningioma can lead to neurological deterioration that, at times, can result in a permanent deficit even after successful surgery.

Clinical presentation and outcome of patients with intradural spinal cord tumours

“…A good pre-operative status was a significant predictor of a positive outcome at discharge, which was also noted by previous authors. 15,18,19 We agree with the hypothesis of Epstein et al 19 that, particularly in IMSCT, worse post-operative outcome in patients with large, long-standing tumours may be attributed to thinning of the spinal parenchyma.…”

“…[10][11][12][13][14][15][16] Older studies, such as Levy et al 12 which reports a mean duration of symptoms prior to diagnosis of 23 months, have longer time to diagnosis compared to recent studies, which cite a mean duration of symptoms of 9.5 months to 13.7 months. 10,15,16 This suggests that advancements in imaging and tumour detection have shortened the symptomatic duration of patients before admission by aiding earlier diagnosis. Furthermore, secondary tumours are now often detected early, due to the periodic follow-up of patients after the initial primary tumour resection, and therefore had a shorter symptomatic period, which further contributes to the overall shorter symptom duration before admission.…”

Complication Avoidance in the Resection of Spinal Meningiomas

“…After surgical resection, the rates of recurrence of spinal meningioma are similar to rates of meningioma arising in the cranial compartment (36,47). Recurrences have been reported in 0%e 17% (median 4) of cases (5,15,17,22,23,30,39,43,44,48,51,55,56,58,61), and recurrence was noted more frequently in tumors that were ventrally attached (44), previously recurrent, infiltrative, partially resected, or with arachnoid scarring (23).…”

Hemilaminectomy for spinal meningioma: A case series of 20 patients with a focus on ventral- and ventrolateral lesions

“…The risk of postsurgical cerebrospinal-fluid leak was minimal (none was recorded in our series) (1,11,29). Dural repair was possible by direct suturing in almost every case, as described above.…”

“…The excision of ventrally located tumors is usually achieved through a posterior approach (1,19,20,(23)(24)(25)(26)(27)(28)(29). Laminectomy has long been the procedure of choice for these lesions; however, due to posterior-column impairment associated with removal of the posterior lamina, the spinous process, and the posterior ligaments, spinal stability is often affected (30)(31)(32).…”