TY - JOUR
T1 - Simpson grade I-III resection of spinal atypical (world health organization grade II) meningiomas is associated with symptom resolution and low recurrence
AU - Sun, Sam Q.
AU - Cai, Chunyu
AU - Ravindra, Vijay M.
AU - Gamble, Paul
AU - Yarbrough, Chester K.
AU - Dacey, Ralph G.
AU - Dowling, Joshua L.
AU - Zipfel, Gregory J.
AU - Wright, Neill M.
AU - Santiago, Paul
AU - Robinson, Clifford G.
AU - Schmidt, Meic H.
AU - Kim, Albert H.
AU - Ray, Wilson Z.
N1 - Publisher Copyright:
Copyright © 2015 by the Congress of Neurological Surgeons.
PY - 2015/6/25
Y1 - 2015/6/25
N2 - Background: Because of their rarity, outcomes regarding spinal atypical meningiomas (AMs) remain unclear. OBJECTIVE: To describe the recurrence rate and postoperative outcomes after resection of spinal AMs, and to discuss an appropriate resection strategy and adjuvant therapy for spinal AMs. METHODS: Data from all patients who presented with spinal AMs to 2 tertiary referral centers between 1998 and 2013 were obtained by chart review. RESULTS: From 102 patients with spinal meningioma, 20 AM tumors (7 cervical, 11 thoracic, 2 thoracolumbar) were identified in 18 patients (median age, 50 years [range, 19-75] at time of resection; 11% male; median follow-up, 32 months [range, 1-179] after resection). Before resection, patients had sensory deficits (70%), pain (70%), weakness (60%), ataxia (50%), spasticity (65%), and incontinence (35%). One tumor presented asymptomatically. Simpson grade I, II, III, and IV resection were achieved in 3 (15%), 13 (65%), 2 (10%), and 2 (10%) tumors, respectively. One patient that underwent Simpson grade III resection received adjuvant radiation therapy. After Simpson grade I-III or gross total resection, no tumors recurred (0%; confidence interval, 0%-17.6%). After Simpson grade IV resection, 1 tumor recurred (50%; confidence interval, 1.3%-98.7%). With the exception of 1 patient who had bilateral paraplegia perioperatively, all other patients experienced improvement of preoperative symptoms after surgery (median time, 3.6 months [range, 1-13] after resection). CONCLUSION: Despite published cases suggesting an aggressive clinical course for spinal AMs, this series of spinal AMs reports that gross total resection without adjuvant radiation therapy resulted in symptom resolution and low recurrence..
AB - Background: Because of their rarity, outcomes regarding spinal atypical meningiomas (AMs) remain unclear. OBJECTIVE: To describe the recurrence rate and postoperative outcomes after resection of spinal AMs, and to discuss an appropriate resection strategy and adjuvant therapy for spinal AMs. METHODS: Data from all patients who presented with spinal AMs to 2 tertiary referral centers between 1998 and 2013 were obtained by chart review. RESULTS: From 102 patients with spinal meningioma, 20 AM tumors (7 cervical, 11 thoracic, 2 thoracolumbar) were identified in 18 patients (median age, 50 years [range, 19-75] at time of resection; 11% male; median follow-up, 32 months [range, 1-179] after resection). Before resection, patients had sensory deficits (70%), pain (70%), weakness (60%), ataxia (50%), spasticity (65%), and incontinence (35%). One tumor presented asymptomatically. Simpson grade I, II, III, and IV resection were achieved in 3 (15%), 13 (65%), 2 (10%), and 2 (10%) tumors, respectively. One patient that underwent Simpson grade III resection received adjuvant radiation therapy. After Simpson grade I-III or gross total resection, no tumors recurred (0%; confidence interval, 0%-17.6%). After Simpson grade IV resection, 1 tumor recurred (50%; confidence interval, 1.3%-98.7%). With the exception of 1 patient who had bilateral paraplegia perioperatively, all other patients experienced improvement of preoperative symptoms after surgery (median time, 3.6 months [range, 1-13] after resection). CONCLUSION: Despite published cases suggesting an aggressive clinical course for spinal AMs, this series of spinal AMs reports that gross total resection without adjuvant radiation therapy resulted in symptom resolution and low recurrence..
KW - Adjuvant
KW - Local/therapy
KW - Meningioma/mortality
KW - Meningioma/pathology
KW - Meningioma/therapy
KW - Neoplasm recurrence
KW - Prognosis
KW - Radiotherapy
KW - Retrospective studies
UR - http://www.scopus.com/inward/record.url?scp=84929666399&partnerID=8YFLogxK
U2 - 10.1227/NEU.0000000000000720
DO - 10.1227/NEU.0000000000000720
M3 - Article
C2 - 25774702
AN - SCOPUS:84929666399
SN - 0148-396X
VL - 76
SP - 739
EP - 746
JO - Neurosurgery
JF - Neurosurgery
IS - 6
ER -