Posterior-based resection of spinal meningiomas: an institutional experience of 141 patients with an average of 28 months of follow-up

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  • 1 Department of Neurological Surgery, University of California, San Francisco, California;
  • | 2 Medical Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina; and
  • | 3 Department of Neurosurgery, New York University, New York, New York
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OBJECTIVE

Spinal meningiomas pose unique challenges based on the location of their dural attachment. However, there is a paucity of literature investigating the role of dural attachment location on outcomes after posterior-based approach for spinal meningioma resection. The aim of this study was to investigate any differences in outcomes between dural attachment location subgroups in spinal meningioma patients who underwent posterior-based resection.

METHODS

This was a single-institution review of patients who underwent resection of a spinal meningioma from 1997 to 2017. Surgical, oncological, and neurological outcomes were compared between patients with varying dural attachments. Multivariate analysis was utilized.

RESULTS

A total of 141 patients were identified. The mean age was 62 years, and 110 women were included. The sites of dural attachments were as follows: 16 (11.3%) dorsal, 31 (22.0%) dorsolateral, 17 (12.1%) lateral, 40 (28.4%) ventral, and 37 (26.2%) ventrolateral. Most meningiomas were WHO grade I (92.2%) and in the thoracic spine (61.0%). All patients underwent a posterior approach for tumor resection. There were no differences between subgroups in terms of largest diameter of tumor resected (p = 0.201), gross-total resection (GTR) or subtotal resection (p = 0.362), Simpson grade of resection, perioperative complications (p = 0.116), long-term neurological deficit (p = 0.100), or postoperative radiation therapy (p = 0.971). Cervical spine location was associated with reduced incidence of GTR (OR 0.271, 95% CI 0.108–0.684, p = 0.006) on multivariate analysis. The overall incidence of recurrence/progression was 4.6%, with no difference (p = 0.800) between subgroups. Similarly, the average length of follow-up was 28.1 months, with no difference between subgroups (p = 0.413).

CONCLUSIONS

Posterior-based approaches for resection of spinal meningiomas are safe and effective, regardless of dural attachment location, with similar surgical, oncological, and neurological outcomes. Comparison of long-term recurrence rates between dural attachment subgroups is required.

ABBREVIATIONS

AP = anteroposterior; GTR = gross-total resection; LOS = length of stay; ML = mediolateral; SI = superoinferior; STR = subtotal resection.

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  • 1

    Riad H, Knafo S, Segnarbieux F, Lonjon N. Spinal meningiomas: surgical outcome and literature review. Neurochirurgie. 2013;59(1):3034.

  • 2

    Maiti TK, Bir SC, Patra DP, Kalakoti P, Guthikonda B, Nanda A. Spinal meningiomas: clinicoradiological factors predicting recurrence and functional outcome. Neurosurg Focus. 2016;41(2):E6.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3

    Nakamura M, Tsuji O, Fujiyoshi K, et al. Long-term surgical outcomes of spinal meningiomas. Spine (Phila Pa 1976). 2012;37(10):E617E623.

  • 4

    Sandalcioglu IE, Hunold A, Müller O, Bassiouni H, Stolke D, Asgari S. Spinal meningiomas: critical review of 131 surgically treated patients. Eur Spine J. 2008;17(8):10351041.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5

    Gezen F, Kahraman S, Çanakci Z, Bedük A. Review of 36 cases of spinal cord meningioma. Spine (Phila Pa 1976). 2000;25(6):727731.

  • 6

    Onken J, Obermüller K, Staub-Bartelt F, Meyer B, Vajkoczy P, Wostrack M. Surgical management of spinal meningiomas: focus on unilateral posterior approach and anterior localization. J Neurosurg Spine. 2018;30(3):308313.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 7

    Lonjon N, Russo V, Barbarisi M, Choi D, Allibone J, Casey A. Spinal cervical meningiomas: the challenge posed by ventral location. World Neurosurg. 2016;89:464473.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8

    Payer M. The anterior approach to anterior cervical meningiomas: review illustrated by a case. Acta Neurochir (Wien). 2005;147(5):555560.

  • 9

    Simpson D. The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry. 1957;20(1):22.

  • 10

    Zhang Z. Model building strategy for logistic regression: purposeful selection. Ann Transl Med. 2016;4(6):111.

  • 11

    Mickey RM, Greenland S. The impact of confounder selection criteria on effect estimation. Am J Epidemiol. 1989;129(1):125137.

  • 12

    Gottfried ON, Gluf W, Quinones-Hinojosa A, Kan P, Schmidt MH. Spinal meningiomas: surgical management and outcome. Neurosurg Focus. 2003;14(6):e2.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 13

    Cohen-Gadol AA, Zikel OM, Koch CA, Scheithauer BW, Krauss WE. Spinal meningiomas in patients younger than 50 years of age: a 21-year experience. J Neurosurg. 2003;98(3)(suppl):258263.

    • Search Google Scholar
    • Export Citation
  • 14

    Peker S, Cerçi A, Ozgen S, Isik N, Kalelioglu M, Pamir MN. Spinal meningiomas: evaluation of 41 patients. J Neurosurg Sci. 2005;49(1):711.

    • Search Google Scholar
    • Export Citation
  • 15

    Schaller B. Spinal meningioma: relationship between histological subtypes and surgical outcome? J Neurooncol. 2005;75(2):157161.

  • 16

    Setzer M, Vatter H, Marquardt G, Seifert V, Vrionis FD. Management of spinal meningiomas: surgical results and a review of the literature. Neurosurg Focus. 2007;23(4):E14.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17

    Yoon SH, Chung CK, Jahng TA. Surgical outcome of spinal canal meningiomas. J Korean Neurosurg Soc. 2007;42(4):300304.

  • 18

    Boström A, Bürgel U, Reinacher P, et al. A less invasive surgical concept for the resection of spinal meningiomas. Acta Neurochir (Wien). 2008;150(6):551556.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19

    Postalci L, Tugcu B, Gungor A, Guclu G. Spinal meningiomas: recurrence in ventrally located individuals on long-term follow-up; a review of 46 operated cases. Turk Neurosurg. 2011;21(4):449453.

    • Search Google Scholar
    • Export Citation
  • 20

    Iacob G. Spinal meningiomas. Personal experience and review of literature. Rom Neurosurg. 2014;21(2):147161.

  • 21

    Arima H, Takami T, Yamagata T, et al. Surgical management of spinal meningiomas: a retrospective case analysis based on preoperative surgical grade. Surg Neurol Int. 2014;5(7)(suppl 7):S333S338.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 22

    Kim CH, Chung CK. Surgical outcome of a posterior approach for large ventral intradural extramedullary spinal cord tumors. Spine (Phila Pa 1976). 2011;36(8):E531E537.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 23

    Safaee M, Parsa AT, Barbaro NM, et al. Association of tumor location, extent of resection, and neurofibromatosis status with clinical outcomes for 221 spinal nerve sheath tumors. Neurosurg Focus. 2015;39(2):E5.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24

    Barber SM, Konakondla S, Nakhla J, et al. Oncologic benefits of dural resection in spinal meningiomas: a meta-analysis of Simpson grades and recurrence rates. J Neurosurg Spine. 2020;32(3):441451.

    • Crossref
    • Search Google Scholar
    • Export Citation

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