Functional Outcome after Spinal Meningioma Surgery

Abstract

Study design: A multicenter cross-sectional analytical retrospective study.

Purpose: To assess functional outcome (FO) after a spinal meningioma (SM) surgery.

Overview of literature: All studies report functional improvement after SM removal.

Methods: We performed an analytical retrospective cohort study at five different institutions. All patients with a diagnosis of SM were included in this study, including those with recurrent tumors. Meningiomas of the foramen magnum were excluded. Useful histopathological characteristics were separately extracted. Surgical resection was evaluated according to the Simpson grading scale. Patient outcomes and clinical states were assessed with the help of their medical records using four different scales: the modified Ranawat score, the Nurick scale, the Prolo score, the Frankel grade, and the Eastern Cooperative Oncology Group-World Health Organization- Zubrod score.

Results: Between 1991 and 2018, 417 patients were identified, of which 85.8% were female. The median age at surgery was 67.2 years (interquartile range [IQR], 56.7-76.5). The lesion was located in the thoracic region in 77.9% of the patients, cervical region in 16.8%, and lumbar region in 4.1%. Surgical resection was complete in 95.5% of the cases. Only 0.96% of the patients died within the first postoperative month. Neurological status, which improved in 76.9% of the patients, was unchanged in 17.5% and even worsened in 4.4%. Functional status was assessed using the Ranawat score and Nurick scale, with scores of 1 (IQR, 0-2) (i.e., hyperreflexia and asymptomatic; mean, 1.3±1.3) and 1 (IQR, 0-2) (i.e., signs of spinal cord disease, but no difficulty in walking; mean, 1.2±1.4), respectively. Approximately 10.1% of the patients were not ambulant at the last neurosurgical follow-up visit. Older age at surgery was not significantly associated with a chair-bound status (p =0.427).

Conclusions: This large series confirms the favorable FO after spinal meningioma surgery even in the case of seriously impaired preoperative status. A validated scale is needed to assess the factors predicting a worsening of the functional status and guide the management of patients.

Keywords: Functional outcome; Meningioma; Spine.

Fig. 1

Count of meningioma by spinal level.

Fig. 2

Functional status at presentation, evolution, and at last neurosurgical follow-up. (A) Functional status at presentation according the Eastern Cooperative Oncology Group (ECOG)–World Health Organization (WHO)–Zubrod score. (B) Alluvial plot of the functional status evolution according the ECOG–WHO–Zubrod score. (C) Functional outcome according the ECOG–WHO–Zubrod score. (D) Functional status at presentation according the Frankel grade. (E) Alluvial plot of the functional status evolution according the Frankel grade. (F) Functional outcome according the Frankel grade.

Fig. 3

Functional status at last neurosurgical follow-up. (A) Functional outcome according the modified Ranawat score. (B) Functional outcome according the Nurick score. (C) Functional outcome according the Prolo scale.

Fig. 4

Linear regression plots of the scales used for functional status assessment at presentation and at last neurosurgical follow-up (FU). (A, B) Eastern Cooperative Oncology Group (ECOG)–World Health Organization (WHO)–Zubrod at presentation by Frankel at presentation. (C, D) Modified Ranawat score at last FU by ECOG–WHO–Zubrod at presentation. (E, F) Modified Ranawat score at last FU by ECOG–WHO–Zubrod at last FU.