Matthias Setzer, Hartmut Vatter, Gerhard Marquardt, Volker Seifert and Frank D. Vrionis
In this report, the authors describe their experience in the surgical management of spinal meningiomas at two neurosurgical centers. The results of a literature review are also presented.
Eighty consecutive patients (22 men and 58 women) with spinal meningiomas who had undergone an operation at two specific neurosurgical centers were included in this study. Functional outcomes were evaluated using univariate and multivariate analyses. A review of the literature yielded an additional 651 patients with spinal meningiomas from 9 large studies.
On multivariate analysis, the variable of a poor preoperative neurological state (p < 0.02, odds ratio [OR] 13.6, 95% confidence interval [CI] 2.6–71.4) and invasion of the arachnoid/pia mater (p < 0.03, OR 15.2, 95% CI 2.5–90.4) were independent predictors of a poor outcome, whereas invasion of the arachnoid/pia (p < 0.02, OR 8.9, 95% CI 2.2–35) and duration of symptoms (p < 0.001, OR 1.12/month, 95% CI 1.05–1.2) predicted no improvement (stable or deteriorated condition). The Cox proportional hazards regression analysis showed three significant predictor variables for recurrence: invasion of the arachnoid/pia (p < 0.05; hazard ratio [HR] 1.8, 95% CI 1.2–3.6), Simpson resection grade (p < 0.012, HR 6.8, 95% CI 1.5–3.0), and histological tumor grade (Grade I; p < 0.001, HR 0.001–0.17).
Because of the excellent outcome of surgery for benign spinal meningiomas and the association between duration of symptoms and neurological compromise with a poor functional outcome, early operation is the treatment of choice. In cases of malignant transformation, adjuvant therapies must be considered.
Matthias Setzer, Frank D. Vrionis, Elvis J. Hermann, Volker Seifert and Gerhard Marquardt
The authors examined a possible association between apolipoprotein E (APOE) gene polymorphism and the outcome after anterior microsurgical decompression in patients with cervical spondylotic myelopathy (CSM).
The authors conducted a prospective study of 60 consecutive patients (40 men, 20 women) with CSM who underwent anterior microsurgical decompression. The patients ranged in age from 26 to 86 years (mean 61.5 ± 14.6 years). Neurological deficits were classified according to the modified Japanese Orthopaedic Association Scale. Mean follow-up was 18.8 ± 4.6 months and APOE genotyping was carried out by isolation of DNA from venous blood samples. The APOE genotypes were determined by polymerase chain reaction followed by restriction enzyme digestion and polyacrylamide gel electrophoresis of digested fragments. Categorical variables were analyzed with the chi-square test, continuous data with the Mann-Whitney U-test, and for multiple groups with the Kruskal-Wallis H-test. A backward stepwise binary logistic regression analysis was performed to determine the effect of APOE in a multivariate model.
Of the 60 patients with CSM, 35 (58.3%) improved and 25 (41.7%) did not improve or suffered deterioration (no-improvement group). In the improvement group 5 patients (8.3%) possessed the ε4 allele compared with 16 patients (26.7%) in the no-improvement group (p = 0.002, OR 3.3, 95% CI 1.7–6.1). In a multivariate model, the occurrence of the ε4 allele was a significant independent predictor for no improvement after anterior decompression and fusion (p = 0.004, OR 8.6, 95% CI 5.1–20.6).
The results of this study show that APOE gene polymorphism influences the short-term outcome of CSM patients after surgical decompressive and stabilizing therapy in the way that the presence of the APOE ε4 allele is an independent predictor for a no improvement. The presence of APOE may explain in part the different responses to operative therapies in patients with cervical myelopathy.
Presented at the 2009 Joint Spine Section Meeting
Matthias Setzer, Ryan D. Murtagh, F. Reed Murtagh, Mohammed Eleraky, Surbhi Jain, Gerhard Marquardt, Volker Seifert and Frank D. Vrionis
The aim of this retrospective study was to evaluate the predictive value of diffusion tensor (DT) imaging with respect to resectability of intramedullary spinal cord tumors and to determine the concordance of this method with intraoperative surgical findings.
Diffusion tensor imaging was performed in 14 patients with intramedullary lesions of the spinal cord at different levels using a 3-T magnet. Routine MR imaging scans were also obtained, including unenhanced and enhanced T1-weighted images and T2-weighted images. Patients were classified according to the fiber course with respect to the lesion and their lesions were rated as resectable or nonresectable. These results were compared with the surgical findings (existence vs absence of cleavage plane). The interrater reliability was calculated using the κ coefficient of Cohen.
Of the 14 patients (7 male, 7 female; mean age 49.2 ± 15.5 years), 13 had tumors (8 ependymomas, 2 lymphomas, and 3 astrocytoma). One lesion was proven to be a multiple sclerosis plaque during further diagnostic workup. The lesions could be classified into 3 types according to the fiber course. In Type 1 (5 cases) fibers did not pass through the solid lesion. In Type 2 (3 cases) some fibers crossed the lesion, but most of the lesion volume did not contain fibers. In Type 3 (6 cases) the fibers were completely encased by tumor. Based on these results, 6 tumors were considered resectable, 7 were not. During surgery, 7 tumors showed a good cleavage plane, 6 did not. The interrater reliability (Cohen κ) was calculated as 0.83 (p < 0.003), which is considered to represent substantial agreement. The mean duration of follow-up was 12.0 ± 2.9. The median McCormick grade at the end of follow-up was II.
These preliminary data suggest that DT imaging in patients with spinal cord tumors is capable of predicting the resectability of the lesion. A further prospective study is needed to confirm these results and any effect on patient outcome.