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Spinal Meningiomas

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Spinal Cord Tumors

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Abstract

Spinal meningiomas make up less than 25% of all spine tumors, and are far less frequent than intracranial tumors. In the few last decades, a better knowledge of these tumors has significantly improved the surgical management of spinal cord meningiomas by demonstrating the relationship between patient status, outcome and the tumor pathology, tumor location and ossification; improvements in neurophysiological monitoring and neuro-anesthesia and the development of innovative variations to the traditional approaches to spinal cord tumors. In this chapter, we summarize the typical features of spinal meningiomas listing by incidence, prevalence, clinical and radiological patterns and histopathological types. Moreover, we describe the various types of surgical approaches usually performed for spinal meningioma excision, including the posterior approach, posterolateral approach, and anterior approach. We also describe the new T-line concept, which could be useful for decision-making about the most feasible approach for each case. Finally, we describe possible complications of this surgery and how to avoid them.

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References

  1. Ogden AT, Schwartz TH, McCormick PC. Spinal cord tumors in adults. In: Winn HR, editor. Youmans neurological surgery. 6th ed. Philadelphia, PA: Saunders; 2011. p. 3130–43.

    Google Scholar 

  2. Albanese V, Platania N. Spinal intradural extramedullary tumors. Personal experience. J Neurosurg Sci. 2002;46(1):18–24.

    CAS  PubMed  Google Scholar 

  3. Helseth A, Mork SJ (1989) Primary intraspinal neoplasms in Norway, 1955 to 1986. A population-based survey of 467 patients. J Neurosurg 71 (6):842–845. https://doi.org/10.3171/jns.1989.71.6.0842.

  4. Nittner K (1976) Spinal meningiomas, neurinomas and neurofibromas and hourglass tumors. In: Vinkin PJ, Bruyn GW (eds) Handbook of clinical neurology. 20 North Holland publishing, Amsterdam, pp 179–322.

    Google Scholar 

  5. Rasmussen TB, Kernohan JW, Adson AW. Pathologic classification, with surgical consideration, of Intraspinal tumors. Ann Surg. 1940;111(4):513–30.

    Article  CAS  Google Scholar 

  6. Levy WJ Jr, Bay J, Dohn D. Spinal cord meningioma. J Neurosurg. 1982;57(6):804–12. https://doi.org/10.3171/jns.1982.57.6.0804.

    Article  PubMed  Google Scholar 

  7. Sandalcioglu IE, Hunold A, Muller O, Bassiouni H, Stolke D, Asgari S. Spinal meningiomas: critical review of 131 surgically treated patients. Eur Spine J. 2008;17(8):1035–41. https://doi.org/10.1007/s00586-008-0685-y.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Solero CL, Fornari M, Giombini S, Lasio G, Oliveri G, Cimino C, Pluchino F. Spinal meningiomas: review of 174 operated cases. Neurosurgery. 1989;25(2):153–60.

    Article  CAS  Google Scholar 

  9. Westwick HJ, Shamji MF. Effects of sex on the incidence and prognosis of spinal meningiomas: a surveillance, epidemiology, and end results study. J Neurosurg Spine. 2015;23(3):368–73. https://doi.org/10.3171/2014.12.SPINE14974.

    Article  PubMed  Google Scholar 

  10. Goutagny S, Kalamarides M. Meningiomas and neurofibromatosis. J Neuro-Oncol. 2010;99(3):341–7. https://doi.org/10.1007/s11060-010-0339-x.

    Article  Google Scholar 

  11. Perry A, Giannini C, Raghavan R, Scheithauer BW, Banerjee R, Margraf L, Bowers DC, Lytle RA, Newsham IF, Gutmann DH. Aggressive phenotypic and genotypic features in pediatric and NF2-associated meningiomas: a clinicopathologic study of 53 cases. J Neuropathol Exp Neurol. 2001;60(10):994–1003.

    Article  CAS  Google Scholar 

  12. Mautner VF, Lindenau M, Baser ME, Hazim W, Tatagiba M, Haase W, Samii M, Wais R, Pulst SM. The neuroimaging and clinical spectrum of neurofibromatosis 2. Neurosurgery. 1996;38(5):880–5. discussion 885-886

    Article  CAS  Google Scholar 

  13. Gezen F, Kahraman S, Canakci Z, Beduk A. Review of 36 cases of spinal cord meningioma. Spine (Phila Pa 1976). 2000;25(6):727–31.

    Article  CAS  Google Scholar 

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

    Article  Google Scholar 

  15. King AT, Sharr MM, Gullan RW, Bartlett JR. Spinal meningiomas: a 20-year review. Br J Neurosurg. 1998;12(6):521–6.

    Article  CAS  Google Scholar 

  16. Klekamp J, Samii M. Surgical results for spinal meningiomas. Surg Neurol. 1999;52(6):552–62.

    Article  CAS  Google Scholar 

  17. Roux FX, Nataf F, Pinaudeau M, Borne G, Devaux B, Meder JF. Intraspinal meningiomas: review of 54 cases with discussion of poor prognosis factors and modern therapeutic management. Surg Neurol. 1996;46(5):458–63. discussion 463-454

    Article  CAS  Google Scholar 

  18. Parsa AT, Lee J, Parney IF, Weinstein P, McCormick PC, Ames C. Spinal cord and intradural-extraparenchymal spinal tumors: current best care practices and strategies. J Neuro-Oncol. 2004;69(1–3):291–318.

    Article  Google Scholar 

  19. Schaller B, Heilbronner R, Pfaltz CR, Probst RR, Gratzl O. Preoperative and postoperative auditory and facial nerve function in cerebellopontine angle meningiomas. Otolaryngol Head Neck Surg. 1995;112(2):228–34. https://doi.org/10.1016/S0194-59989570241-5.

    Article  CAS  PubMed  Google Scholar 

  20. Vadivelu S, Sharer L, Schulder M. Regression of multiple intracranial meningiomas after cessation of long-term progesterone agonist therapy. J Neurosurg. 2010;112(5):920–4. https://doi.org/10.3171/2009.8.JNS09201.

    Article  CAS  PubMed  Google Scholar 

  21. Wiemels J, Wrensch M, Claus EB. Epidemiology and etiology of meningioma. J Neuro-Oncol. 2010;99(3):307–14. https://doi.org/10.1007/s11060-010-0386-3.

    Article  Google Scholar 

  22. Bickerstaff ER, Rasmussen TB. Pathologic classification, with surgical consideration, of intraspinal tumors. Ann Surg. 1940;111(4):513–53.

    Article  Google Scholar 

  23. Schoenberg BS, Christine BW, Whisnant JP. Nervous system neoplasms and primary malignancies of other sites. The unique association between meningiomas and breast cancer. Neurology. 1975;25(8):705–12.

    Article  CAS  Google Scholar 

  24. Schaller B. Spinal meningioma: relationship between histological subtypes and surgical outcome? J Neuro-Oncol. 2005;75(2):157–61. https://doi.org/10.1007/s11060-005-1469-4.

    Article  Google Scholar 

  25. Saraceni C, Harrop JS. Spinal meningioma: chronicles of contemporary neurosurgical diagnosis and management. Clin Neurol Neurosurg. 2009;111(3):221–6. https://doi.org/10.1016/j.clineuro.2008.10.018.

    Article  PubMed  Google Scholar 

  26. McCormick PC, Post KD, Stein BM. Intradural extramedullary tumors in adults. Neurosurg Clin N Am. 1990;1(3):591–608.

    Article  CAS  Google Scholar 

  27. Van Goethem JW, van den Hauwe L, Ozsarlak O, De Schepper AM, Parizel PM. Spinal tumors. Eur J Radiol. 2004;50(2):159–76. https://doi.org/10.1016/j.ejrad.2003.10.021.

    Article  PubMed  Google Scholar 

  28. Cheng MK. Spinal cord tumors in the People's Republic of China: a statistical review. Neurosurgery. 1982;10(1):22–4.

    Article  CAS  Google Scholar 

  29. Hijiya N, Hudson MM, Lensing S, Zacher M, Onciu M, Behm FG, Razzouk BI, Ribeiro RC, Rubnitz JE, Sandlund JT, Rivera GK, Evans WE, Relling MV, Pui CH. Cumulative incidence of secondary neoplasms as a first event after childhood acute lymphoblastic leukemia. JAMA. 2007;297(11):1207–15. https://doi.org/10.1001/jama.297.11.1207.

    Article  CAS  PubMed  Google Scholar 

  30. Neglia JP, Robison LL, Stovall M, Liu Y, Packer RJ, Hammond S, Yasui Y, Kasper CE, Mertens AC, Donaldson SS, Meadows AT, Inskip PD. New primary neoplasms of the central nervous system in survivors of childhood cancer: a report from the childhood Cancer survivor study. J Natl Cancer Inst. 2006;98(21):1528–37. https://doi.org/10.1093/jnci/djj411.

    Article  PubMed  Google Scholar 

  31. Umansky F, Shoshan Y, Rosenthal G, Fraifeld S, Spektor S. Radiation-induced meningioma. Neurosurg Focus. 2008;24(5):E7. https://doi.org/10.3171/FOC/2008/24/5/E7.

    Article  PubMed  Google Scholar 

  32. Cushing H, Eisenhardt L. Meningiomas: their classification, regional behavior, life history and surgical end results. Springfield, IL: Charles C Thomas; 1938.

    Google Scholar 

  33. Gowers WR, Horsley V. A case of tumour of the spinal cord. Removal; recovery. Med Chir Trans. 1888;71(377–430):311.

    Google Scholar 

  34. Mulholland RC. Sir William Gowers 1845-1915. Spine (Phila Pa 1976). 1996;21(9):1106–10.

    Article  CAS  Google Scholar 

  35. Perry A, Gutmann DH, Reifenberger G. Molecular pathogenesis of meningiomas. J Neuro-Oncol. 2004;70(2):183–202. https://doi.org/10.1007/s11060-004-2749-0.

    Article  Google Scholar 

  36. National Institute of Neurological Disorders and Stroke. Brain and spinal cord tumors: hope through research. Bethesda, MD: National Institutes of Health; 2009.

    Google Scholar 

  37. Traul DE, Shaffrey ME, Schiff D. Part I: spinal-cord neoplasms-intradural neoplasms. Lancet Oncol. 2007;8(1):35–45. https://doi.org/10.1016/S1470-2045(06)71009-9.

    Article  PubMed  Google Scholar 

  38. Haegelen C, Morandi X, Riffaud L, Amlashi SF, Leray E, Brassier G. Results of spinal meningioma surgery in patients with severe preoperative neurological deficits. Eur Spine J. 2005;14(5):440–4. https://doi.org/10.1007/s00586-004-0809-y.

    Article  CAS  PubMed  Google Scholar 

  39. Stechison MT, Tasker RR, Wortzman G. Spinal meningioma en plaque. Report of two cases. J Neurosurg. 1987;67(3):452–5. https://doi.org/10.3171/jns.1987.67.3.0452.

    Article  CAS  PubMed  Google Scholar 

  40. Blaylock RL. Hydrosyringomyelia of the conus medullaris associated with a thoracic meningioma: case report. J Neurosurg. 1981;54(6):833–5. https://doi.org/10.3171/jns.1981.54.6.0833.

    Article  CAS  PubMed  Google Scholar 

  41. Weil SM, Gewirtz RJ, Tew JM Jr. Concurrent intradural and extradural meningiomas of the cervical spine. Neurosurgery. 1990;27(4):629–31.

    Article  CAS  Google Scholar 

  42. 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. https://doi.org/10.3171/FOC-07/10/E14.

    Article  PubMed  Google Scholar 

  43. Raftopoulos C, Baleriaux D, Flament-Durand J, Delecluse F, Brotchi J. Cylindrical spinal meningioma. A case report. Surg Neurol. 1993;40(5):411–3.

    Article  CAS  Google Scholar 

  44. Vergara P. Is the complete excision of circumferential intradural spinal meningiomas achievable? Acta Neurochir. 2017;159(12):2385–8. https://doi.org/10.1007/s00701-017-3354-2.

    Article  PubMed  Google Scholar 

  45. Sayagues JM, Tabernero MD, Maillo A, Trelles O, Espinosa AB, Sarasquete ME, Merino M, Rasillo A, Vera JF, Santos-Briz A, de Alava E, Garcia-Macias MC, Orfao A. Microarray-based analysis of spinal versus intracranial meningiomas: different clinical, biological, and genetic characteristics associated with distinct patterns of gene expression. J Neuropathol Exp Neurol. 2006;65(5):445–54. https://doi.org/10.1097/01.jnen.0000229234.13372.d8.

    Article  CAS  PubMed  Google Scholar 

  46. Parisi JE, Mena H. Non-glial tumors. In: Nelson JS, Parisi JE, Schochet SS, editors. Principles and practice of neuropathology. Inc, St. Louis, MO: Mosby-Year Book; 1993. p. 203–66.

    Google Scholar 

  47. Doita M, Harada T, Nishida K, Marui T, Kurosaka M, Yoshiya S. Recurrent calcified spinal meningioma detected by plain radiograph. Spine (Phila Pa 1976). 2001;26(11):E249–52.

    Article  CAS  Google Scholar 

  48. Ruggeri AG, Fazzolari B, Colistra D, Cappelletti M, Marotta N, Delfini R. Calcified spinal Meningiomas. World Neurosurg. 2017;102:406–12. https://doi.org/10.1016/j.wneu.2017.03.045.

    Article  PubMed  Google Scholar 

  49. Chotai SP, Mrak RE, Mutgi SA, Medhkour A. Ossification in an extra-intradural spinal meningioma-pathologic and surgical vistas. Spine J. 2013;13(12):e21–6. https://doi.org/10.1016/j.spinee.2013.06.102.

    Article  PubMed  Google Scholar 

  50. Cochran EJ, Schlauderaff A, Rand SD, Eckardt GW, Kurpad S. Spinal osteoblastic meningioma with hematopoiesis: radiologic-pathologic correlation and review of the literature. Ann Diagn Pathol. 2016;24:30–4. https://doi.org/10.1016/j.anndiagpath.2016.07.002.

    Article  PubMed  Google Scholar 

  51. Huang TY, Kochi M, Kuratsu J, Ushio Y. Intraspinal osteogenic meningioma: report of a case. J Formos Med Assoc. 1999;98(3):218–21.

    CAS  PubMed  Google Scholar 

  52. Licci S, Limiti MR, Callovini GM, Bolognini A, Gammone V, Di Stefano D. Ossified spinal tumour in a 58-year-old woman with increasing paraparesis. Neuropathology. 2010;30(2):194–6. https://doi.org/10.1111/j.1440-1789.2009.01076.x.

    Article  PubMed  Google Scholar 

  53. Arslantas A, Artan S, Oner U, Durmaz R, Muslumanoglu H, Atasoy MA, Basaran N, Tel E. Detection of chromosomal imbalances in spinal meningiomas by comparative genomic hybridization. Neurol Med Chir (Tokyo). 2003;43(1):12–8. discussion 19

    Article  Google Scholar 

  54. Ketter R, Henn W, Niedermayer I, Steilen-Gimbel H, Konig J, Zang KD, Steudel WI. Predictive value of progression-associated chromosomal aberrations for the prognosis of meningiomas: a retrospective study of 198 cases. J Neurosurg. 2001;95(4):601–7. https://doi.org/10.3171/jns.2001.95.4.0601.

    Article  CAS  PubMed  Google Scholar 

  55. Dodd RL, Ryu MR, Kamnerdsupaphon P, Gibbs IC, Chang SD Jr, Adler JR Jr. CyberKnife radiosurgery for benign intradural extramedullary spinal tumors. Neurosurgery. 2006;58(4):674–85.; discussion 674-685. https://doi.org/10.1227/01.NEU.0000204128.84742.8F.

    Article  PubMed  Google Scholar 

  56. Tredway TL, Santiago P, Hrubes MR, Song JK, Christie SD, Fessler RG (2006) Minimally invasive resection of intradural-extramedullary spinal neoplasms. Neurosurgery 58(1 Suppl):ONS52-58; discussion ONS52-58.

    Google Scholar 

  57. De Verdelhan O, Haegelen C, Carsin-Nicol B, Riffaud L, Amlashi SF, Brassier G, Carsin M, Morandi X. MR imaging features of spinal schwannomas and meningiomas. J Neuroradiol. 2005;32(1):42–9.

    Article  Google Scholar 

  58. Aoki S, Sasaki Y, Machida T, Tanioka H. Contrast-enhanced MR images in patients with meningioma: importance of enhancement of the dura adjacent to the tumor. AJNR Am J Neuroradiol. 1990;11(5):935–8.

    CAS  PubMed  Google Scholar 

  59. Goldsher D, Litt AW, Pinto RS, Bannon KR, Kricheff II. Dural "tail" associated with meningiomas on Gd-DTPA-enhanced MR images: characteristics, differential diagnostic value, and possible implications for treatment. Radiology. 1990;176(2):447–50. https://doi.org/10.1148/radiology.176.2.2367659.

    Article  CAS  PubMed  Google Scholar 

  60. Nagele T, Petersen D, Klose U, Grodd W, Opitz H, Voigt K. The "dural tail" adjacent to meningiomas studied by dynamic contrast-enhanced MRI: a comparison with histopathology. Neuroradiology. 1994;36(4):303–7.

    Article  CAS  Google Scholar 

  61. Salpietro FM, Alafaci C, Lucerna S, Iacopino DG, Tomasello F. Do spinal meningiomas penetrate the pial layer? Correlation between magnetic resonance imaging and microsurgical findings and intracranial tumor interfaces. Neurosurgery. 1997;41(1):254–7. discussion 257-258

    Article  CAS  Google Scholar 

  62. Lee RR. MR imaging of intradural tumors of the cervical spine. Magn Reson Imaging Clin N Am. 2000;8(3):529–40.

    CAS  PubMed  Google Scholar 

  63. Caroli E, Acqui M, Roperto R, Ferrante L, D'Andrea G. Spinal en plaque meningiomas: a contemporary experience. Neurosurgery. 2004;55(6):1275–9. discussion 1279

    Article  Google Scholar 

  64. Jiang L, Lv Y, Liu XG, Ma QJ, Wei F, Dang GT, Liu ZJ. Results of surgical treatment of cervical dumbbell tumors: surgical approach and development of an anatomic classification system. Spine (Phila Pa 1976). 2009;34(12):1307–14. https://doi.org/10.1097/BRS.0b013e3181a27a32.

    Article  Google Scholar 

  65. Ito K, Aoyama T, Miyaoka Y, Seguchi T, Horiuchi T, Hongo K. Surgery for ventral intradural thoracic spinal tumors with a posterolateral transpedicular approach. Acta Neurochir. 2016;158(8):1563–9. https://doi.org/10.1007/s00701-016-2864-7.

    Article  PubMed  Google Scholar 

  66. Tachibana T, Maruo K, Inoue S, Arizumi F, Kusuyama K, Yoshiya S. A new concept for making decisions regarding the surgical approach for spinal meningiomas: the T-line, a preliminary stud. Interdisc Neurosurg. 2016;3:11–4.

    Article  Google Scholar 

  67. Angevine PD, Kellner C, Haque RM, McCormick PC. Surgical management of ventral intradural spinal lesions. J Neurosurg Spine. 2011;15(1):28–37. https://doi.org/10.3171/2011.3.SPINE1095.

    Article  PubMed  Google Scholar 

  68. Slin'ko EI, Al Q II. Intradural ventral and ventrolateral tumors of the spinal cord: surgical treatment and results. Neurosurg Focus. 2004;17(1):ECP2.

    Article  Google Scholar 

  69. Tsuda K, Akutsu H, Yamamoto T, Nakai K, Ishikawa E, Matsumura 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). 2014;54(11):907–13.

    Article  Google Scholar 

  70. Nakamura M, Tsuji O, Fujiyoshi K, Hosogane N, Watanabe K, Tsuji T, Ishii K, Toyama Y, Chiba K, Matsumoto M. Long-term surgical outcomes of spinal meningiomas. Spine (Phila Pa 1976). 2012;37(10):E617–23. https://doi.org/10.1097/BRS.0b013e31824167f1.

    Article  Google Scholar 

  71. Alafaci C, Grasso G, Granata F, Salpietro FM, Tomasello F. Ossified spinal meningiomas: clinical and surgical features. Clin Neurol Neurosurg. 2016;142:93–7. https://doi.org/10.1016/j.clineuro.2016.01.026.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Neurosurgery Unit, Department of Neurology and Psychiatry, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy

    Roberto Delfini & Davide Colistra

  2. Department of Neurosurgery, Ospedale S. M. Goretti, Sapienza University of Rome, Latina, Italy

    Benedetta Fazzolari

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  1. Roberto Delfini
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Editors and Affiliations

  1. Department of Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA

    Kenan I. Arnautović

  2. Department of Neurosurgery, Warren Alpert School of Medicine at Brown University, Rhode Island Hospital, Providence, RI, USA

    Ziya L. Gokaslan

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Delfini, R., Fazzolari, B., Colistra, D. (2019). Spinal Meningiomas. In: Arnautović, K.I., Gokaslan, Z.L. (eds) Spinal Cord Tumors. Springer, Cham. https://doi.org/10.1007/978-3-319-99438-3_9

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