Spinal Meningiomas: Influence of Cord Compression and Radiological Features on Preoperative Functional Status and Outcome
by
, , , , and
Valentina Baro
1
,
Alessandro Moiraghi
2,3,4,*,
Valentina Carlucci
5,
Luca Paun
3,
Mariagiulia Anglani
6,
Mario Ermani
7,
Andrea Saladino
8,
Franco Chioffi
9,
Domenico d’Avella
1,
Andrea Landi
1
,
Andrea Bartoli
3,
Francesco DiMeco
8,10,11,
Karl Schaller
3, 
Luca Denaro
1 and
Enrico Tessitore
3 1
Academic Neurosurgery, Department of Neurosciences, University of Padova, 35128 Padova, Italy
2
Department of Neurosurgery, GHU Paris-Sainte-Anne Hospital, 75014 Paris, France
3
Division of Neurosurgery, Department of Clinical Neurosciences, Geneva University Hospitals and Faculty of Medicine, University of Geneva, 1211 Geneva, Switzerland
4
Institut de Psychiatrie et Neurosciences de Paris (IPNP), UMR S1266, INSERM, IMA-BRAIN, 75014 Paris, France
5
Division of Neurology, Department of Neurosciences, University of Padova, 35128 Padova, Italy
6
Neuroradiology Unit, Azienda Ospedaliera Università di Padova, 35128 Padova, Italy
7
Department of Neurosciences, University of Padova, 35128 Padova, Italy
8
Neurosurgery Department, Fondazione IRCCS Istituto Neurologico Nazionale “C. Besta”, 20133 Milan, Italy
9
Division of Neurosurgery, Azienda Ospedaliera Università di Padova, 35128 Padova, Italy
10
Department of Pathophysiology and Transplantation, University of Milan, 20122 Milan, Italy
11
Department of Neurological Surgery, Johns Hopkins Medical School, Baltimore, MD 21205, USA
*
Author to whom correspondence should be addressed.
Cancers 2021, 13(16), 4183; https://doi.org/10.3390/cancers13164183
Submission received: 25 June 2021
/
Revised: 12 August 2021
/
Accepted: 14 August 2021
/
Published: 20 August 2021
(This article belongs to the Special Issue Meningioma Surgery and Functional Outcome)
Simple Summary
Patients affected by spinal meningioma globally exhibit an excellent postoperative functional outcome despite tumor size and severity of spinal cord compression. This work aims to analyze the impact of tumor size and other radiological findings on clinical functional preoperative status and postoperative outcome. In this multicentric retrospective study involving 90 adult patients, we found that spinal cord and tumor occupancy as well as cord compression and tumor volume are correlated with low preoperative functional status. Higher tumor occupancy and tumor-canal volume ratio corresponded to lower postoperative neurological recovery. Cord re-expansion did not show any correlation with postoperative outcome, while preoperative signs of cord myelopathy were predictors of worse postoperative outcome. These findings suggest that these radiological features should be taken into consideration during preoperative counselling.
Abstract
Background: Radiological parameters predicting the postoperative neurological outcome after resection of a spinal meningioma (SM) are poorly studied, with controversial results. Methods: Observational multicenter cohort (2011–2018) of adult patients undergoing surgery for resection of SM. Tumor-canal volume ratio (TCR), the areas related to the cord and tumor occupancy at maximum compression, the presence of dural tail, calcifications, signs of myelopathy, and postoperative cord expansion were compared with the modified McCormick scale (mMCS) preoperative and at follow-up. Results: In the cohort (n = 90 patients), cord and tumor occupancy as well as cord compression and tumor volume showed a correlation with preoperative mMCS (p < 0.05, R −0.23; p < 0.001, R 0.35; p < 0.005, R −0.29; p < 0.001, R 0.42). Cord occupancy had a strong correlation with cord compression (p < 0.001, R 0.72). Tumor occupancy and TCR were correlated with relative outcome at follow-up (p < 0.005 R 0.3; p < 0.005 R 0.29). No correlation was found between cord re-expansion and clinical outcome at follow-up. Finally, a correlation was shown between preoperative signs of cord myelopathy and mMCS (p < 0.05 R 0.21) at follow-up. Conclusions: Larger tumors showed lower preoperative functional status and a worse clinical outcome. Moreover, preoperative T2 cord signal changes are correlated with a poorer outcome.
