Journal of Neuro-Oncology

, Volume 140, Issue 1, pp 49–54 | Cite as

Spinal meningioma and factors predictive of post-operative deterioration

  • Vianney GilardEmail author
  • Alice Goia
  • François-Xavier Ferracci
  • Florent Marguet
  • Nicolas Magne
  • Olivier Langlois
  • Alexis Perez
  • Stéphane Derrey
Clinical Study



Spinal meningiomas are slow-growing intradural-extramedullary tumors. They are usually associated with good outcomes. However, there are few descriptions of factors predictive of impaired evolution. Our objective was to identify predictive factors of post-operative deterioration as well as outcomes at follow-up.


Between 2009 and 2016, 87 patients had surgery for spinal meningioma in our referral center. Clinical presentation, management and outcomes were reported during the post-operative period and at 3-month follow-up. Evaluation was based on post-operative neurological deterioration defined as an increase of at least one point in the McCormick score compared to the status at admission.


During the study period, post-operative deterioration occurred in 17 patients (19.5%). Risk factors associated with this deterioration were the absence of pre-operative neurological signs (Relative Risk; RR = 2.38, p = 0.04), an anterior location of the meningioma and a grade 2 meningioma on WHO classification score (RR = 6, p ≤ 0.01). At 3-month follow-up, in patients who initially presented with a motor deficit, partial recovery was found in 75%, stability in 20% and a deterioration of their clinical status in 5%. After a mean follow-up of 92.4 ± 51.9 months, the recurrence rate was 8%.


Spinal meningiomas are usually benign tumors whose treatment is based on complete surgical resection. Progress in surgical techniques has resulted in lower morbidity rates and improvement in post-operative recovery. In this study, we observed several factors associated with clinical deterioration. Before surgery, patients should be fully informed of these predictive factors of post-operative deterioration and their association with surgical morbidity.


Spinal meningioma Surgical outcome Prognostic factors Spinal tumor Intradural Extramedullary 



The authors are grateful to Nikki Sabourin-Gibbs, Rouen University Hospital, for her help in editing the manuscript.

Compliance with ethical standards

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study. Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.


  1. 1.
    Roux FX, Nataf F, Pinaudeau M et al (1996) Intraspinal meningiomas: review of 54 cases with discussion of poor prognosis factors and modern therapeutic management. Surg Neurol 46:458–463; discussion 463–464CrossRefGoogle Scholar
  2. 2.
    Westwick HJ, Yuh S-J, Shamji MF (2015) Complication avoidance in the resection of spinal meningiomas. World Neurosurg 83:627–634CrossRefGoogle Scholar
  3. 3.
    Westwick HJ, Shamji MF (2015) Effects of sex on the incidence and prognosis of spinal meningiomas: a Surveillance, Epidemiology, and End Results study. J Neurosurg Spine 23:368–373CrossRefGoogle Scholar
  4. 4.
    Banan R, Hartmann C (2017) The new WHO 2016 classification of brain tumors—what neurosurgeons need to know. Acta Neurochir (Wien)Google Scholar
  5. 5.
    Schaller B (2005) Spinal meningioma: relationship between histological subtypes and surgical outcome? J Neurooncol 75:157–161CrossRefGoogle Scholar
  6. 6.
    Yamaguchi S, Takeda M, Takahashi T et al (2015) Ginkgo leaf sign: a highly predictive imaging feature of spinal meningioma. J Neurosurg Spine 23:642–646CrossRefGoogle Scholar
  7. 7.
    Quekel LG, Versteege CW (1995) The “dural tail sign” in MRI of spinal meningiomas. J Comput Assist Tomogr 19:890–892CrossRefGoogle Scholar
  8. 8.
    Takami T, Yamagata T, Shimokawa N et al (2014) Surgical management of spinal meningiomas: a retrospective case analysis based on preoperative surgical grade. Surg Neurol Int 5:333CrossRefGoogle Scholar
  9. 9.
    Afathi M, Peltier E, Adetchessi T et al (2015) Minimally invasive transmuscular approach for the treatment of benign intradural extramedullary spinal cord tumours: technical note and results. Neurochirurgie 61:333–338CrossRefGoogle Scholar
  10. 10.
    Turel MK, D’Souza WP, Rajshekhar V (2015) Hemilaminectomy approach for intradural extramedullary spinal tumors: an analysis of 164 patients. Neurosurg Focus 39:E9CrossRefGoogle Scholar
  11. 11.
    Gottfried ON, Gluf W, Quinones-Hinojosa A et al (2003) Spinal meningiomas: surgical management and outcome. Neurosurg Focus 14:1–7Google Scholar
  12. 12.
    Riad H, Knafo S, Segnarbieux F, Lonjon N (2013) Spinal meningiomas: surgical outcome and literature review. Neurochirurgie 59:30–34CrossRefGoogle Scholar
  13. 13.
    McCormick PC, Post KD, Stein BM (1990) Intradural extramedullary tumors in adults. Neurosurg Clin N Am 1:591–608CrossRefGoogle Scholar
  14. 14.
    Cohen ME, Marino RJ (2000) The tools of disability outcomes research functional status measures. Arch Phys Med Rehabil 81:S21–S29CrossRefGoogle Scholar
  15. 15.
    SIMPSON D (1957) The recurrence of intracranial meningiomas after surgical treatment. J Neurol Neurosurg Psychiatry 20:22–39CrossRefGoogle Scholar
  16. 16.
    Sacko O, Rabarijaona M, Loiseau H (2008) La chirurgie des méningiomes rachidiens après 75 ans. Neurochirurgie 54:512–516CrossRefGoogle Scholar
  17. 17.
    Haegelen C, Morandi X, Riffaud L et al (2005) Results of spinal meningioma surgery in patients with severe preoperative neurological deficits. Eur Spine J 14:440–444CrossRefGoogle Scholar
  18. 18.
    Reszec J, Hermanowicz A, Rutkowski R et al (2015) Expression of MMP-9 and VEGF in meningiomas and their correlation with peritumoral brain edema. BioMed Res Int 2015:1–8Google Scholar
  19. 19.
    Levy WJJ, Bay J, Dohn D (1982) Spinal cord meningioma. J Neurosurg 57:804–812CrossRefGoogle Scholar
  20. 20.
    Lazorthes G, Gouaze A, Zadeh JO et al (1971) Arterial vascularization of the spinal cord. J Neurosurg 35:253–262CrossRefGoogle Scholar
  21. 21.
    Pompili A, Caroli F, Crispo F et al (2016) Unilateral laminectomy approach for the removal of spinal meningiomas and schwannomas: impact on pain, spinal stability, and neurologic results. World Neurosurg 85:282–291CrossRefGoogle Scholar
  22. 22.
    Sandalcioglu IE, Hunold A, Müller O et al (2008) Spinal meningiomas: critical review of 131 surgically treated patients. Eur Spine J 17:1035–1041CrossRefGoogle Scholar
  23. 23.
    Solero CL, Fornari M, Giombini S et al (1989) Spinal meningiomas: review of 174 operated cases. Neurosurgery 25:153–160CrossRefGoogle Scholar
  24. 24.
    Klekamp J, Samii M (1999) Surgical results for spinal meningiomas. Surg Neurol 52:552–562CrossRefGoogle Scholar
  25. 25.
    Kim CH, Chung CK, Lee S-H et al (2015) Long-term recurrence rates after the removal of spinal meningiomas in relation to Simpson grades. Eur Spine JGoogle Scholar
  26. 26.
    Nakamura M, Tsuji O, Fujiyoshi K et al (2012) Long-term surgical outcomes of spinal meningiomas. Spine 37:E617–E623CrossRefGoogle Scholar
  27. 27.
    Sachdev S, Dodd RL, Chang SD et al (2011) Stereotactic radiosurgery yields long-term control for benign intradural, extramedullary spinal tumors. Neurosurgery 69:533–539CrossRefGoogle Scholar
  28. 28.
    Kufeld M, Wowra B, Muacevic A et al (2012) Radiosurgery of spinal meningiomas and schwannomas. Technol Cancer Res Treat 11:27–34CrossRefGoogle Scholar
  29. 29.
    Gerszten PC, Burton SA, Ozhasoglu C et al (2008) Radiosurgery for benign intradural spinal tumors. Neurosurgery 62:887–895; discussion 895–896CrossRefGoogle Scholar
  30. 30.
    Golanov AV, Konovalov NA, Antipina NA et al (2015) [Stereotactic radiotherapy for spinal meningiomas and neurinomas]. Zh Vopr Neirokhir Im N N Burdenko 79:4–13CrossRefGoogle Scholar
  31. 31.
    King AT, Sharr MM, Gullan RW, Bartlett JR (1998) Spinal meningiomas: a 20-year review. Br J Neurosurg 12:521–526CrossRefGoogle Scholar
  32. 32.
    Gezen F, Kahraman S, Canakci Z, Beduk A (2000) Review of 36 cases of spinal cord meningioma. Spine 25:727–731CrossRefGoogle Scholar
  33. 33.
    Ahmed R, Menezes AH, Awe OO et al (2014) Long-term incidence and risk factors for development of spinal deformity following resection of pediatric intramedullary spinal cord tumors: clinical article. J Neurosurg Pediatr 13:613–621CrossRefGoogle Scholar
  34. 34.
    McGirt MJ, Chaichana KL, Atiba A et al (2008) Incidence of spinal deformity after resection of intramedullary spinal cord tumors in children who underwent laminectomy compared with laminoplastyGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of NeurosurgeryRouen University HospitalRouenFrance
  2. 2.Normandie Univ, UNIROUEN, INSERM U1245, Laboratory of Microvascular Endothelium and Neonate Brain LesionsRouenFrance
  3. 3.Department of NeuropathologyRouen University HospitalRouenFrance
  4. 4.Department of RadiologyRouen University HospitalRouenFrance
  5. 5.Normandie Univ, UNIROUEN, INSERM UMR 1073, Laboratory Nutrition, Gut and BrainRouenFrance

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