gms | German Medical Science

Objective: The surgical strategy for spinal meningiomas usually consists of initial tumor debulking, identification of the interface between tumor and spinal cord, resection of the dura including the matrix of the tumor, and duroplasty (Simpson grade I resection). The objective of this study is to investigate if a less invasive surgical strategy, which is reduced to tumor removal and coagulation of the tumor matrix (Simpson grade II resection), allows to obtain comparable surgical results without an increase of the recurrence rate.

Method: Within the last two decades, 96 patients (21 men, 75 women) underwent first surgery for a spinal meningioma. In 91 of the 96 patients, Simpson grade II resection was performed. In 5 patients, dura resection and duroplasty was additionally done after tumor removal (Simpson grade I). Electrophysiological monitoring was routinely used. Recurrency was defined as new onset or worsening of symptoms and/or radiological confirmation of tumor growth at the former tumor site.

Results: In 92 of the 96 patients (96%) improvement of the preoperative symptoms (motor deficit n=48, sensory deficit n=29, ataxia n=19, pain n=10) could be observed already during the hospital stay. Four patients (4%) experienced a temporary symptom worsening, but improved later to a better (n=3) or the same preoperative status. Three complications (pseudomeningocele, wound infection) (3%), requiring surgery, were encountered. The pseudomeningocele developed in a patient who underwent Simpson grade I resection. During the follow-up period of 8 years (mean), 2 patients required surgery for recurrence; one recurrence occurred 7 years after Simpson grade II resection (1%), the other 3 years after Simpson grade I resection.

Conclusions: The high rate of favorable clinical results combined with the very low rate of recurrences support the less invasive surgical concept of Simpson grade II resection in spinal meningioma.