Spinal meningiomas

Abstract

Spinal meningiomas (SM) are lesions with a mostly favorable oncological and surgical prognosis and a low incidence of tumor recurrence. SM account for approximately 1.2-12.7% of all meningiomas and 25% of all spinal cord tumors. Typically, SM are located in the intradural extramedullary space. SM grow slowly and spread laterally into the subarachnoid space, stretching and sometimes incorporating the surrounding arachnoid but rarely the pia. Standard treatment is surgery with the primary aims of achieving complete tumor resection as well as improving and recovering neurologic function. Radiotherapy may be considered in case of tumor recurrence, for challenging surgical cases, and for patients with higher-grade lesions (World Health Organization grade 2 or 3); however, radiotherapy is mostly used as an adjuvant therapy for SM. New molecular and genetic profiling increases the understanding of SM and may uncover additional treatment options.

Keywords: molecular and genetic targets; recurrence rate; surgical therapy.

Figure 1.

Preoperative MR image showing a classic case of homogeneously enhancing cervical spinal meningioma in (A) sagittal and (B) axial T1 contrast-enhanced sequences and significant compression of the spinal cord.

Figure 2.

(A) Preoperative T2-MR image of an intradural space-occupying lesion at level L5, showing (B) homogenous contrast enhancement on T1-MR imaging. This lesion was a lumbal spinal solitary fibrous tumor, also termed hemangiopericytoma, WHO II, which reflects one of the possible differential diagnoses when a spinal meningioma is suspected in preoperative MR imaging. (C) The intraoperative ultrasound image confirmed the correct level and extent of surgical access before dural opening. (D) In contrast to most spinal meningiomas, this tumor showed a more reddish coloration during surgery, which is indicative of higher vascularization.

Figure 3.

Intraoperative view of a large intradural cervical meningioma.