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Spinal meningiomas: is Simpson grade II resection radical enough?

  • Original Article - Tumor - Meningioma
  • Published:
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Abstract

Background

The optimal treatment for spinal meningioma is complete resection. The radicality of resection is the most important predictive factor for future tumor recurrence. Although clinical series dedicated to spinal meningiomas are relatively frequent, only a minimum of these defines the length of the required follow-up and difference in tumor recurrence in the context of Simpson grade I and II resection. Therefore, we propose reconsideration of surgical treatment and long-term follow-up based on a retrospective analysis of 84 patients who underwent Simpson grade II resection.

Methods

The study included 84 patients operated between 1998 and 2018. Clinical symptomatology, age, sex, risk of comorbidities, spinal level, duration of symptoms, surgical resection radicality, tumor recurrence, and complications associated with treatment were recorded and evaluated.

Results

We encountered the diagnosis of spinal meningioma considerably more often in women (81%) than in men (19%). The average age of all patients was 65 years. Most meningiomas were located in the thoracic spine (82%) while the rest (18%) were located in the cervical spine. The most common symptoms were motor deficit (80%) and sensation disorders (70%). Of the symptomatic patients, 71% clinically improved, 27% showed no change and 2% worsened postoperatively. The mean follow-up was 32 months (range 1–204). During this period, there was a 5% tumor recurrence rate. However, when we analyzed a subgroup of nine patients who were monitored for more than 6 years, tumor recurrence was diagnosed in 44%, all of whom were women (mean age 51 years).

Conclusion

Our results indicate that tumor recurrence after Simpson II resection could be significantly higher than previously thought if the follow-up is long enough, especially in younger patients. This finding suggests we consider using radical Simpson grade I resection more frequently. The study also demonstrates that after spinal meningioma surgery the patients should be followed and monitored on a long-term basis.

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Abbreviations

MMS:

Modified McCormick scale

MRI:

Magnetic resonance imaging

WHO:

World Health Organization

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Funding

Our study was supported by the following grants: Q28/LF1, MO IP 1012, and NV19-04-00272.

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Authors and Affiliations

  1. Department of Neurosurgery and Neuro-oncology, First Medical Faculty, Central Military Hospital, Charles University in Prague, U Vojenské nemocnice 1200/1, 169 02, Prague 6, Czech Republic

    Richard Voldřich, David Netuka & Vladimír Beneš

Authors
  1. Richard Voldřich
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  2. David Netuka
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  3. Vladimír Beneš
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Corresponding author

Correspondence to David Netuka.

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Conflict of interest

The authors declare that they have no conflict of interest.

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. For this type of study, formal consent is not required.

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Comments

Voldrich et al. present an interesting case series of 84 patients who were diagnosed with an intraspinal meningioma and subsequently resected according to Simpson grade II. The patients were collected over the last two decades from 1998 to 2018 and all treated at one institution. Twenty years is a long inclusion period, but 13 surgeons for 84 cases in a single center may suggest that intraspinal surgery should be kept on fewer hands in the future. During a mean follow-up of 32 months, 4 patients were diagnosed with a recurrence. Only 2 patients had a second surgery, but these patients had a significantly longer follow-up of more than 96 months.

Interestingly, 24% of all the enrolled patients experienced a prolonged hospital stay due to various minor and major complications. Twelve patients out of 19 patients with prolonged postoperative stay in hospital underwent revision surgery. This proportion represents 14% of all enrolled patients in the study, which is a rather high revision rate. The majority of patients had an improved or similar MMS score post-op, and only 2 patients experienced worsening in symptoms after treatment according to the MMS score. Around 840 MRIs must be performed according to the proposed follow-up program to find all reported recurrences in the study. This means 420 MRIs per surgery for a tumor recurrence. A more pragmatic approach could be patient education that emphasizes on sensibility disturbances, gait difficulties, or problems with balance. After all, this is a slow-growing benign disease.

Case series like this are not only valuable for the daily practice of a neurosurgeon but also for the planning of future prospective studies and follow-up programs in outpatient clinics. In addition, the authors provide a nice summarized overview over similar published studies.

Jesper Kelsen

Denmark

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Voldřich, R., Netuka, D. & Beneš, V. Spinal meningiomas: is Simpson grade II resection radical enough?. Acta Neurochir 162, 1401–1408 (2020). https://doi.org/10.1007/s00701-020-04280-2

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  • DOI: https://doi.org/10.1007/s00701-020-04280-2

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