Oncologic benefits of dural resection in spinal meningiomas: a meta-analysis of Simpson grades and recurrence rates

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OBJECTIVE

While resection of the dural attachment has been shown by Simpson and others to reduce recurrence rates for intracranial meningiomas, the oncological benefit of dural resection for spinal meningiomas is less clear. The authors performed a systematic analysis of the literature, comparing recurrence rates for patients undergoing various Simpson grade resections of spinal meningiomas to better understand the role of dural resection on outcomes after resection of spinal meningiomas.

METHODS

The PubMed/Medline database was systematically searched to identify studies describing oncological and clinical outcomes after Simpson grade I, II, III, or IV resections of spinal meningiomas.

RESULTS

Thirty-two studies describing the outcomes of 896 patients were included in the analysis. Simpson grade I, grade II, and grade III/IV resections were performed in 27.5%, 64.6%, and 7.9% of cases, respectively. The risk of procedure-related complications (OR 4.75, 95% CI 1.27–17.8, p = 0.021) and new, unexpected postoperative neurological deficits (OR ∞, 95% CI NaN–∞, p = 0.009) were both significantly greater for patients undergoing Simpson grade I resections when compared with those undergoing Simpson grade II resections. Tumor recurrence was seen in 2.8%, 4.1%, and 39.4% of patients undergoing Simpson grade I, grade II, and grade III/IV resections over a mean radiographic follow-up period of 99.3 ± 46.4 months, 95.4 ± 57.1 months, and 82.4 ± 49.3 months, respectively. No significant difference was detected between the recurrence rates for Simpson grade I versus Simpson grade II resections (OR 1.43, 95% CI 0.61–3.39, p = 0.43). A meta-analysis of 7 studies directly comparing recurrence rates for Simpson grade I and II resections demonstrated a trend toward a decreased likelihood of recurrence after Simpson grade I resection when compared with Simpson grade II resection, although this trend did not reach statistical significance (OR 0.56, 95% CI 0.23–1.36, p = 0.20).

CONCLUSIONS

The results of this analysis suggest with a low level of confidence that the rates of complications and new, unexpected neurological deficits after Simpson grade I resection of spinal meningiomas are greater than those seen with Simpson grade II resections, and that the recurrence rates for Simpson grade I and grade II resections are equivalent, although additional, long-term studies are needed before reliable conclusions may be drawn.

Article Information

Contributor Notes

Correspondence Ziya L. Gokaslan: Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI. ziya_gokaslan@brown.edu.INCLUDE WHEN CITING Published online November 8, 2019; DOI: 10.3171/2019.8.SPINE19859.Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.
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References
  • 1

    Angevine PDKellner CHaque RMMcCormick PC: Surgical management of ventral intradural spinal lesions. J Neurosurg Spine 15:28372011

    • Search Google Scholar
    • Export Citation
  • 2

    Barbanera ANina PSerchi EAscanio F: Aggressive recurrence of intra-extradural cervico-thoracic meningothelial meningioma. Acta Neurochir (Wien) 149:83862007

    • Search Google Scholar
    • Export Citation
  • 3

    Boström ABürgel UReinacher PKrings TRohde VGilsbach JM: A less invasive surgical concept for the resection of spinal meningiomas. Acta Neurochir (Wien) 150:5515562008

    • Search Google Scholar
    • Export Citation
  • 4

    Cohen-Gadol AAZikel OMKoch CAScheithauer BWKrauss WE: Spinal meningiomas in patients younger than 50 years of age: a 21-year experience. J Neurosurg 98 (3 Suppl):2582632003

    • Search Google Scholar
    • Export Citation
  • 5

    Cushing HEisenhardt L: Meningiomas. Their Classification Regional Behaviour Life History and Surgical End Results. Springfield, IL: Charles C Thomas1938

    • Search Google Scholar
    • Export Citation
  • 6

    Deshmukh VRHott JSDickman CA: Surgical treatment of epidural and transforaminal spinal meningiomas. Barrow Q 21:14172005

  • 7

    Ehresman JSGarzon-Muvdi TRogers DLim MGallia GLWeingart J: The relevance of Simpson grade resections in modern neurosurgical treatment of World Health Organization Grade I, II, and III meningiomas. World Neurosurg 109:e588e5932018

    • Search Google Scholar
    • Export Citation
  • 8

    Gallagher MJJenkinson MDBrodbelt ARMills SJChavredakis E: WHO grade 1 meningioma recurrence: are location and Simpson grade still relevant? Clin Neurol Neurosurg 141:1171212016

    • Search Google Scholar
    • Export Citation
  • 9

    Gezen FKahraman SÇanakci ZBedük A: Review of 36 cases of spinal cord meningioma. Spine (Phila Pa 1976) 25:7277312000

  • 10

    Gottfried ONGluf WQuinones-Hinojosa AKan PSchmidt MH: Spinal meningiomas: surgical management and outcome. Neurosurg Focus 14(6):e22003

    • Search Google Scholar
    • Export Citation
  • 11

    Gousias KSchramm JSimon M: The Simpson grading revisited: aggressive surgery and its place in modern meningioma management. J Neurosurg 125:5515602016

    • Search Google Scholar
    • Export Citation
  • 12

    Haegelen CMorandi XRiffaud LAmlashi SFALeray EBrassier G: Results of spinal meningioma surgery in patients with severe preoperative neurological deficits. Eur Spine J 14:4404442005

    • Search Google Scholar
    • Export Citation
  • 13

    Haq NShah RKhan HUsman MAli M: Outcome of surgical management in spinal meningioma: a study of 48 cases. Gomal J Med Sci 13:49532015

    • Search Google Scholar
    • Export Citation
  • 14

    Hasseleid BFMeling TRRønning PScheie DHelseth E: Surgery for convexity meningioma: Simpson Grade I resection as the goal: clinical article. J Neurosurg 117:99910062012

    • Search Google Scholar
    • Export Citation
  • 15

    Heald JBCarroll TAMair RJ: Simpson grade: an opportunity to reassess the need for complete resection of meningiomas. Acta Neurochir (Wien) 156:3833882014

    • Search Google Scholar
    • Export Citation
  • 16

    Horn EMDeshmukh VRLekovic GPDickman CA: Durectomy and reconstruction for the treatment of a recurrent spinal meningioma. Case report. J Neurosurg Spine 5:76782006

    • Search Google Scholar
    • Export Citation
  • 17

    Iacob G: Spinal meningiomas. Personal experience and review of literature. Rom Neurosurg 21:1471612014

  • 18

    Ito KImagama SAndo KKobayashi KHida TTsushima M: Discrimination between spinal extradural meningioma and both intra and extradural meningioma: case report. Nagoya J Med Sci 79:1151212017

    • Search Google Scholar
    • Export Citation
  • 19

    Kawaguchi YIshihara HAbe YSeki STokunaga AUrushizaki A: Fatal prognosis of an atypical meningioma in the cervical spine. J Orthop Sci 13:1551592008

    • Search Google Scholar
    • Export Citation
  • 20

    Kayaselçuk FZorludemir SBal NErdogan BErdogan SErman T: The expression of survivin and Ki-67 in meningiomas: correlation with grade and clinical outcome. J Neurooncol 67:2092142004

    • Search Google Scholar
    • Export Citation
  • 21

    Ketter RHenn WNiedermayer ISteilen-Gimbel HKönig JZang KD: Predictive value of progression-associated chromosomal aberrations for the prognosis of meningiomas: a retrospective study of 198 cases. J Neurosurg 95:6016072001

    • Search Google Scholar
    • Export Citation
  • 22

    Kim CHChung CKLee SHJahng TAHyun SJKim KJ: Long-term recurrence rates after the removal of spinal meningiomas in relation to Simpson grades. Eur Spine J 25:402540322016

    • Search Google Scholar
    • Export Citation
  • 23

    King ATSharr MMGullan RWBartlett JR: Spinal meningiomas: a 20-year review. Br J Neurosurg 12:5215261998

  • 24

    Krause F: Surgery of the Brain and Spinal Cord. Haubold HAThorek M (transl). London: Lewis1910

  • 25

    Lanzafame STorrisi ABarbagallo GEmmanuele CAlberio NAlbanese V: Correlation between histological grade, MIB-1, p53, and recurrence in 69 completely resected primary intracranial meningiomas with a 6 year mean follow-up. Pathol Res Pract 196:4834882000

    • Search Google Scholar
    • Export Citation
  • 26

    Levy WJ JrBay JDohn D: Spinal cord meningioma. J Neurosurg 57:8048121982

  • 27

    Maiti TKBir SCPatra DPKalakoti PGuthikonda BNanda A: Spinal meningiomas: clinicoradiological factors predicting recurrence and functional outcome. Neurosurg Focus 41(2):E62016

    • Search Google Scholar
    • Export Citation
  • 28

    Maiuri FDe Caro MLde Divitiis OVergara PMariniello G: Spinal meningiomas: age-related features. Clin Neurol Neurosurg 113:34382011

    • Search Google Scholar
    • Export Citation
  • 29

    Nakamura MTsuji OFujiyoshi KHosogane NWatanabe KTsuji T: Long-term surgical outcomes of spinal meningiomas. Spine (Phila Pa 1976) 37:E617E6232012

    • Search Google Scholar
    • Export Citation
  • 30

    Noh SHKim KHShin DAPark JYYi SKuh SU: Treatment outcomes of 17 patients with atypical spinal meningioma, including 4 with metastases: a retrospective observational study. Spine J 19:2762842019

    • Search Google Scholar
    • Export Citation
  • 31

    Notani NMiyazaki MKanezaki SIshihara TKawano MTsumura H: Surgical management of ventrally located spinal meningiomas via posterior approach. Eur J Orthop Surg Traumatol 27:1811862017

    • Search Google Scholar
    • Export Citation
  • 32

    Payer M: The anterior approach to anterior cervical meningiomas: review illustrated by a case. Acta Neurochir (Wien) 147:5555602005

    • Search Google Scholar
    • Export Citation
  • 33

    Peker SCerçi AOzgen SIsik NKalelioglu MPamir MN: Spinal meningiomas: evaluation of 41 patients. J Neurosurg Sci 49:7112005

    • Search Google Scholar
    • Export Citation
  • 34

    Postalci LTugcu BGungor AGuclu G: Spinal meningiomas: recurrence in ventrally located individuals on long-term follow-up; a review of 46 operated cases. Turk Neurosurg 21:4494532011

    • Search Google Scholar
    • Export Citation
  • 35

    Riad HKnafo SSegnarbieux FLonjon N: Spinal meningiomas: surgical outcome and literature review. Neurochirurgie 59:30342013

  • 36

    Roux FXNataf FPinaudeau MBorne GDevaux BMeder JF: Intraspinal meningiomas: review of 54 cases with discussion of poor prognosis factors and modern therapeutic management. Surg Neurol 46:4584641996

    • Search Google Scholar
    • Export Citation
  • 37

    Rushing EJOlsen CMena HRueda MELee YSKeating RF: Central nervous system meningiomas in the first two decades of life: a clinicopathological analysis of 87 patients. J Neurosurg 103 (6 Suppl):4894952005

    • Search Google Scholar
    • Export Citation
  • 38

    Saito TArizono TMaeda TTerada KIwamoto Y: A novel technique for surgical resection of spinal meningioma. Spine (Phila Pa 1976) 26:180518082001

    • Search Google Scholar
    • Export Citation
  • 39

    Savardekar ARPatra DPBir SThakur JDMohammed NBollam P: Differential tumor progression patterns in skull base versus non-skull base meningiomas: a critical analysis from a long-term follow-up study and review of literature. World Neurosurg 112:e74e832018

    • Search Google Scholar
    • Export Citation
  • 40

    Schick UMarquardt GLorenz R: Recurrence of benign spinal neoplasms. Neurosurg Rev 24:20252001

  • 41

    Schipmann SSchwake MSporns PBVoß KMSicking JSpille DC: Is the Simpson grading system applicable to estimate the risk of tumor progression after microsurgery for recurrent intracranial meningioma? World Neurosurg 119:e589e5972018

    • Search Google Scholar
    • Export Citation
  • 42

    Setzer MVatter HMarquardt GSeifert VVrionis FD: Management of spinal meningiomas: surgical results and a review of the literature. Neurosurg Focus 23(4):E142007

    • Search Google Scholar
    • Export Citation
  • 43

    Simpson D: The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry 20:22391957

  • 44

    Solero CLFornari MGiombini SLasio GOliveri GCimino C: Spinal meningiomas: review of 174 operated cases. Neurosurgery 25:1531601989

    • Search Google Scholar
    • Export Citation
  • 45

    Sun SQCai CRavindra VMGamble PYarbrough CKDacey RG: Simpson grade I–III resection of spinal atypical (World Health Organization grade II) meningiomas is associated with symptom resolution and low recurrence. Neurosurgery 76:7397462015

    • Search Google Scholar
    • Export Citation
  • 46

    Svien HJWood MW: Recurrence of a meningioma of the spinal cord after 23 years; report of case. Proc Staff Meet Mayo Clin 32:5735781957

    • Search Google Scholar
    • Export Citation
  • 47

    Takami TNaito KYamagata TYoshimura MArima HOhata K: Posterolateral approach for spinal intradural meningioma with ventral attachment. J Craniovertebr Junction Spine 6:1731782015

    • Search Google Scholar
    • Export Citation
  • 48

    Tsuda KAkutsu HYamamoto TNakai KIshikawa EMatsumura A: Is Simpson grade I removal necessary in all cases of spinal meningioma? Assessment of postoperative recurrence during long-term follow-up. Neurol Med Chir (Tokyo) 54:9079132014

    • Search Google Scholar
    • Export Citation
  • 49

    Ucler NHergunsel BOzturk SKozan SKaplan M: Simpson grade 2 resection and tumor recurrence in ventrally located spinal meningiomas. Turk Neurosurg 28:9799822018

    • Search Google Scholar
    • Export Citation
  • 50

    Voß KMSpille DCSauerland CSuero Molina EBrokinkel CPaulus W: The Simpson grading in meningioma surgery: does the tumor location influence the prognostic value? J Neurooncol 133:6416512017

    • Search Google Scholar
    • Export Citation
  • 51

    Voulgaris SAlexiou GAMihos EKaragiorgiadis DZigouris AFotakopoulos G: Posterior approach to ventrally located spinal meningiomas. Eur Spine J 19:119511992010

    • Search Google Scholar
    • Export Citation
  • 52

    Winther TLTorp SH: Significance of the extent of resection in modern neurosurgical practice of World Health Organization grade I meningiomas. World Neurosurg 99:1041102017

    • Search Google Scholar
    • Export Citation
  • 53

    Yamamuro KSeichi AKimura AKikkawa IKojima MInoue H: Histological investigation of resected dura mater attached to spinal meningioma. Spine (Phila Pa 1976) 37:E1398E14012012

    • Search Google Scholar
    • Export Citation
  • 54

    Yoon SHChung CKJahng TA: Surgical outcome of spinal canal meningiomas. J Korean Neurosurg Soc 42:3003042007

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