[Intraspinal meningiomas. A series of 60 cases]

Abstract

The authors present and compare two consecutive series of spinal meningioma, a total of 60 cases. From the aetiological point of view, the meningioma were more frequent than neurinoma. This study confirms its predominance in the female after the fifth decade. A traumatic factor was sometimes implicated. Anatomically, its localisation predominated in the dorsal region (78.3 p. cent), specially in the first three vertebral segments, and most commonly laterally placed. The strictly epidural meningioma, the multiplicity and the association with a neurinoma were less frequent. On the clinical level, the comparison between the two series illustrated a considerable diminution of the pre-operative evolution of the disease, taking into consideration the existence of spinal deficit less apparent in patients operated after 1963. 54.5 p. cent presented at diagnosis, a total or partial impotence against 81.5 p. cent in the old series. Among the laboratory examinations, the C.D.F. study confirmed slight or even absent cyto-albuminous dissociation, which contrasted markedly with the figures obtained in cases of neurinoma. Plain spinal radiography was usually negative. The radio-opaque myelography revealed a block, sometimes a partial one, very suggestive when bossulated, but which might sometimes mimic a neurinoma or even an epidural lesion. The presence of an arachnoid cyst may give a false level. Surgery was always indicated, regardless of the patients' age. The tumour should be completly removed in a piece-meal fashion with the preservation of the radiculo-medullary elements, which was facilitated by the use of the microscope. To prevent a recurrence, the base of the tumour should be well coagulated or resected followed by a plastic reconstruction of the dura mater. The mortality rate including the late mortality has diminished from 24 p. cent to 11 p. cent. This is essentially due to decubitus in patients who did not improve. The percentage of complete functional recovery rose from 40 p. cent to 66 p. cent of those who survived. The percentage of recovery with sequellae compatible with an autonomous physical activity was stable. The percentage of completly handicaped survivals fell from 28 p. cent to 5 p. cent. The authors conclude that the prognosis for patients with intraspinal menigioma has improved, however the diagnosis is still difficult in the old subject, and there is a serious risk to life when the lesion is in the cervical region.