Nursing review of spinal meningiomas

Abstract

Background:Spinal meningiomas are found in patients typically between the ages of 75 and 84: some report the average age to be 50. They occur with an incidence of approximately 1000 patients per year in the US, are mostly single (90%) rather than multiple (10%), and arise from the spinal meninges (arachnoid/dura). Tumors are typically posterior/posterolateral (70%) in location, leaving the remaining 30% in the anterior/anterolateral spinal canal. They produce symptoms and signs of radiculopathy (nerve root) and/or myelopathy (cord compression) depending on their site of origin.Methods:Meningiomas may be single/sporadic (90%) or multifocal. They may arise primarily/spontaneously, can be radiation-induced, or associated with neurofibromatosis. They are found most frequently in females vs. males in up to a 3.4:1 ratio, occur predominantly in the thoracic spine. They are found in decreasing order in the cervical and lumbar spinal canals. The diagnosis of a meningioma is based on magnetic resonance (MR) studies, where tumors are isointense on T1 weighted MR, and hyperintense onf T2-weighted MR images; they also typically uniformly enhance with Gd-DTPA. On computed tomography (CT) examinations, they are usually characterized as calcified/hyperdense.Results:The neurological deficits resulting from meningiomas and the rapidity of symptom/sign progression dictate whether they are treated surgically or nonsurgically. Management choices include; stereotactic radiation therapy only, and/or in combination with varied surgical resection techniques.Conclusions:The majority of benign spinal cord tumors are meningiomas (40%) that are predominantly found in the thoracic spine in middle-aged females. Tumor levels (e.g. in descending order cervical, thoracic, lumbar), and their location (e.g. anterior/anterolateral 30%; dorsal/dorsolateral 70%) best determine whether nonoperative, operative, and/or operative intervention combined with routine vs. stereotactic radiosurgery are warranted.

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

“…Reported complications associated with radiation exposure of the spinal cord include cord toxicity and neurological deficits [ 53 , 83 , 84 , 86 ]. Radiation-induced myelopathy is one of the most frequently reported complications, occurring in 0.2% to 5% of cases [ 93 ]. Other non-specific complications include nausea, radiation necrosis, constipation, and panic attacks [ 36 ].…”

Long-Term Follow-Up and Predictors of Functional Outcome after Surgery for Spinal Meningiomas: A Population-Based Cohort Study

“…Radiation is not usually indicated for WHO grade I meningiomas, although partially resected and high-grade meningiomas have been suggested to benefit from it. However, patients who receive radiation therapy for spinal meningiomas may also develop late onset radiation-induced myelopathy [42]. Moreover, radiation is typically only feasible once and will make any additional surgery more hazardous, and fractionated radiation therapy is not typically curative for meningiomas.…”

Spinal Meningiomas: A Comprehensive Review and Update on Advancements in Molecular Characterization, Diagnostics, Surgical Approach and Technology, and Alternative Therapies

“…However, in cases where patients are poor surgical candidates, whether due to extensive medical comorbidities, significant tumor extension beyond the intraspinal compartment, multiple tumors, or for those who decline surgery, the primary use of radiotherapy alone is a viable option to delay or halt the progression of symptoms [127]. Reported complications related to radiation treatment include arachnoiditis, radiation necrosis, radiation-induced myelopathy, nausea, panic attacks, and constipation [15,130].…”