Artikel
Assessment of neurological outcome after resection of spinal meningiomas
Einschätzung der neurologischen Ergebnisse nach Resektion von intraspinalen Meningeomen
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Autoren
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Dragan Jankovic
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Neurochirurgische Klinik und Poliklinik, Mainz, Deutschland
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Darius Kalasauskas
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Neurochirurgische Klinik und Poliklinik, Mainz, Deutschland
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Florian Ringel
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Neurochirurgische Klinik und Poliklinik, Mainz, Deutschland
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Naureen Keric
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Neurochirurgische Klinik und Poliklinik, Mainz, Deutschland
| Veröffentlicht: | 25. Mai 2022 |
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Gliederung
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Objective: First line therapy for symptomatic spinal meningiomas is surgery, however, the postoperative outcome may be heterogeneous. The aim of this study was to evaluate potential preoperative clinical and imaging factors influencing the postoperative neurological deterioration.
Methods: We conducted a single-center retrospective analysis of spinal meningiomas that were operated between 2004 and 2019. Demographic, clinical, and radiological data (tumor size, location, occupation ratio and the degree of spinal cord compression), comorbidities, histological features, complications, intraoperative risk factors were recorded. Karnofsky Perfomance Status, Modified McCormick Scale and Frankel Scale were used to assess patients’ functional status before surgery, at discharge and 3-6 months after the surgery.
Results: In total, 121 patients were included in the analysis, mean age was 66 (SD 13) years and 86% were female. The most common location was thoracic (68%) followed by upper (17 %) and lower (12 %) cervical spine. Preoperatively, 2% of patients were categorized as Frankel A, 2% as B, 34% as C, 54% as D, 8% as E. Neurologic function improved in 36%, remained unchanged in 58% and worsened in 4% at the time of discharge. After 3-6 months the proportions changed to 54%, 26% and 5%, respectively. Preoperatively Frankel category correlated significantly with the degree of spinal cord flattening (p=0.014, Spearman’s rho -0.23). No relationship between the presence of T2 hyperintense signal and Frankel score could be established. Postoperative complications were reported in 4.8% of cases (hematoma in 3 patients, CSF fistel in 2 patients, meningitis in 1 patient). No factors associated with worsening of neurological symptoms could be established although the number of cases was limited to five. The degree of cord compression, spinal canal occupation ratio did not have significant effect on outcome.
Conclusion: Surgery of intraspinal meningiomas can be considered as safe. In our cohort there is a correlation between degree of spinal cord compression and preoperative neurological deficits. However, it is not associated with early postoperative outcome.
