gms | German Medical Science

Objective: The majority of surgeries for spinal meningiomas are performed in geriatric patients with commonly poor neurological and medical condition. However, age-related analyses of preoperative symptoms and functional outcomes are rare.

Methods: Clinical, neuropathological and radiological data of 88 patients who underwent surgery for spinal meningiomas were reviewed. Correlations between the patients’ age and preoperative symptoms as well as functional outcome were investigated in uni- and multivariate analyses.

Results: 87 patients with a median age of 67 years (range: 24-91 years) were included. 19 (22%), 31 (35%), 20 (23%), 13 (15%) and 5 (6%) patients presented with preoperative McCormick scores of 1, 2, 3, 4 and 5, respectively. Tumor location correlated with preoperative motor deficits (p=.010) and tumor volume with sciatica (p=.041). Age at the time of surgery was independent of the tumor location, volume, spinal cord compression or myelopathy (p=n.s.). However, preoperative McCormick score increased with rising age (p=.001). Moreover, rates of motor and sensory deficits as well as of incontinence rose (p<.05), while frequency of radicular pain decreased with increasing age (p=.020). Multivariate analyses confirmed an increasing risk of motor deficits with rising age (OR: 1.05, 95%CI 1.01-1.10; p=.017). Simpson grade I, II, III and IV was achieved in 12 (14%), 54 (64%), 14 (17%) and 4 (5%) individuals, respectively. 12 patients developed perioperative complications (14%). Among those, only 3 individuals were younger than 65 years (25%). Postoperative McCormick Score was strongly correlated with preoperative McCormick Score (p=.001), indicating a low functional outcome in patients with severe preoperative deficits. Motor deficits were most likely to improve. A rising age was associated with improvement of motor (p=.006) and sensory deficits (p=.045). In multivariate analyses, probability of improvement of preoperative motor weakness (OR=1.05, 95%CI 1.00-1.10, p=.031) and sensory deficits (OR=1.07, 95%CI 1.01-1.13; p=.014) increased with rising age at the time of diagnosis. Both development of incontinence and radicular pain were independent of the patients’ age.

Conclusion: Despite common preoperative neurological deficits, older patients with spinal meningiomas mostly recover after surgery. However, a thorough evaluation of medical comorbidities is warranted to avoid perioperative complications.