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

OBJECT: 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. METHODS: 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. RESULTS: 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). CONCLUSIONS: 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.