Medical Student, Research Assistant Karolinska University Hospital
Introduction: Spinal meningiomas (SM) are the most common adult primary intradural spinal tumors, disproportionately affecting older female patients. Characterized by a benign histology and slow growth, these tumors cause progressive compression of the spinal cord, eventually leading to neurologic deficits. Surgical resection of SMs is the treatment of choice. There are no recent comprehensive reviews summarizing the current state of evidence associated with SM surgery and its outcomes.
Methods: A systematic review of the literature covering all aspects of spinal meningiomas was performed and a total of 104 studies were included. Meta-analyses were performed when sufficient and satisfactory data was available. The risk of bias including publication bias was thoroughly assessed. The review protocol was registered on PROSPERO and published in a peer-reviewed journal.
Results: The pooled analysis revealed SM surgery to be safe and effective, with a perioperative complication rate of 7.9%, the absolute majority of complications were mild and reversible (Ibanez 1-2). Seventy-nine percent of the patients demonstrated a good postoperative neurological function (McCormick score 1-2). On qualitative analysis, the most relevant predictors of unfavorable outcomes were poor preoperative status, delay in time to surgery, and surgery for recurrent tumors. Other potential predictors, such as higher age, sex, and tumor location, were limited by conflicting results or unsatisfactory data. Although potentially underestimated due to limited follow-up times, the recurrence rate after surgery was estimated at 6%. Meta-analysis and/or survival analysis revealed that higher WHO grade (p < 0.001), higher Simpson grade (p < 0.001), ventral tumor location (p=0.02), and male sex (p=0.014) were all associated with higher odds of recurrence. However, the meta-analysis could not demonstrate any difference between Simpson grade 1 and 2 regarding the odds of recurrence (p=0.94). Finally, surgery was shown to provide durable quality-of-life improvements, as well as a high-frequency of return to work.
Conclusion : SM surgery is a relatively safe procedure with a high likelihood of good postoperative outcomes and a low risk of tumor recurrence. Although a higher extent of resection was associated with smaller odds of recurrence, there were no significant differences when comparing complete removal (Simpson grade 1) with coagulation of the affected dura (grade 2).
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