Factors Leading to a Poor Functional Outcome in Spinal Meningioma Surgery: Remarks on 173 Cases

Abstract BACKGROUND: Spinal meningiomas are common spinal tumors, in most cases benign and with a good surgical prognosis. However, specific location, infiltration of spinal cord, vascular encasement, or spinal root involvement can bring a less favorable prognosis. OBJECTIVE: To correlate these data with clinical/functional outcome. METHODS: Two hundred twenty-four consecutive patients with spinal meningiomas treated from 1976 to 2013 in our institution were analyzed; among these, 51 were excluded for incomplete clinical data or follow-up. The remaining 173 cases were classified in regards to sex, age, symptoms, axial location, Simpson grade resection, and functional pre-/postoperative status. RESULTS: Most recurring onset symptoms were pain (32.9%) and motor deficit (31.8%); thoracic spine was the most severely affected (69.8%). Functional improvement on the follow-up was observed in 86.7% of cases; 6.4% of patients resulted stable and 6.9% worsened. A low functional grade before surgery was connected to a lesser improvement after. Anterolateral meningiomas were the most represented (42.2%); a gross total resection (Simpson grades I and II) was conducted in 98.8%, and a macroscopically complete removal without dural resection or coagulation (Simpson grade III) was performed in 1.2%. Of the meningiomas, 98.3% were classified as WHO grade I. Recurrence rate was 2.3%, and 7 cases presented complications (4 of 7 required surgical procedure). CONCLUSION: We can affirm that negative prognostic factors in our study were anterior or anterolateral axial location, prolonged presentation before diagnosis, WHO grade >I, Simpson grade resections II and III, sphincter involvement, and worse functional grade at onset.

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Spinal meningiomas: clinicoradiological factors predicting recurrence and functional outcome

Neurosurgical FOCUS ◽

10.3171/2016.5.focus16163 ◽

2016 ◽

Vol 41 (2) ◽

pp. E6 ◽

Cited By ~ 27

Author(s):

Tanmoy K. Maiti ◽

Shyamal C. Bir ◽

Devi Prasad Patra ◽

Piyush Kalakoti ◽

Bharat Guthikonda ◽

...

Keyword(s):

Functional Outcome ◽

Wide Spectrum ◽

Neurofibromatosis Type ◽

Spinal Tumors ◽

Benign Tumors ◽

Increased Risk ◽

Dural Tail ◽

Spinal Meningiomas ◽

Signal Changes

OBJECTIVE Spinal meningiomas are benign tumors with a wide spectrum of clinical and radiological features at presentation. The authors analyzed multiple clinicoradiological factors to predict recurrence and functional outcome in a cohort with a mean follow-up of more than 4 years. The authors also discuss the results of clinical studies regarding spinal meningiomas in the last 15 years. METHODS The authors retrospectively reviewed the clinical and radiological details of patients who underwent surgery for spinal tumors between 2001 and 2015 that were histopathologically confirmed as meningiomas. Demographic parameters, such as age, sex, race, and association with neurofibromatosis Type 2, were considered. Radiological parameters, such as tumor size, signal changes of spinal cord, spinal level, number of levels, location of tumor attachment, shape of tumor, and presence of dural tail/calcification, were noted. These factors were analyzed to predict recurrence and functional outcome. Furthermore, a pooled analysis was performed from 13 reports of spinal meningiomas in the last 15 years. RESULTS A total of 38 patients were included in this study. Male sex and tumors with radiological evidence of a dural tail were associated with an increased risk of recurrence at a mean follow-up of 51.2 months. Ventral or ventrolateral location, large tumors, T2 cord signal changes, and poor preoperative functional status were associated with poor functional outcome at 1-year follow-up. CONCLUSIONS Spine surgeons must be aware of the natural history and risk factors of spinal meningiomas to establish a prognosis for their patients.

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Long-Term Follow-Up and Predictors of Functional Outcome after Surgery for Spinal Meningiomas: A Population-Based Cohort Study

Cancers ◽

10.3390/cancers13133244 ◽

2021 ◽

Vol 13 (13) ◽

pp. 3244

Author(s):

Jenny Pettersson-Segerlind ◽

Alexander Fletcher-Sandersjöö ◽

Charles Tatter ◽

Gustav Burström ◽

Oscar Persson ◽

...

Keyword(s):

Spinal Cord ◽

Spinal Cord Compression ◽

Cord Compression ◽

Magnetic Resonance Images ◽

Motor Deficit ◽

Tumor Control ◽

Time To Surgery ◽

Spinal Meningiomas

Spinal meningiomas are the most common adult primary spinal tumor, constituting 24–45% of spinal intradural tumors and 2% of all meningiomas. The aim of this study was to assess postoperative complications, long-term outcomes, predictors of functional improvement and differences between elderly (≥70 years) and non-elderly (18–69 years) patients surgically treated for spinal meningiomas. Variables were retrospectively collected from patient charts and magnetic resonance images. Baseline comparisons, paired testing and regression analyses were used. In conclusion, 129 patients were included, with a median follow-up time of 8.2 years. Motor deficit was the most common presenting symptom (66%). The median time between diagnosis and surgery was 1.3 months. A postoperative complication occurred in 10 (7.8%) and tumor growth or recurrence in 6 (4.7%) patients. Surgery was associated with significant improvement of motor and sensory deficit, gait disturbance, bladder dysfunction and pain. Time to surgery, tumor area and the degree of spinal cord compression significantly predicted postoperative improvement in a modified McCormick scale (mMCs) in the univariable regression analysis, and spinal cord compression showed independent risk association in multivariable analysis. There was no difference in improvement, complications or tumor control between elderly and non-elderly patients. We concluded that surgery of spinal meningiomas was associated with significant long-term neurological improvement, which could be predicted by time to surgery, tumor size and spinal cord compression.

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Functional Outcome Following Synthetic Vertebral Body Implantation in the Management of Spinal Disorders

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2020.3662 ◽

2020 ◽

Vol 8 (B) ◽

pp. 76-80

Author(s):

Moneer K. Faraj ◽

Bassam Mahmood Flamerz Arkawazi ◽

Hazim Moojid Abbas ◽

Zaid Al-Attar

Keyword(s):

Functional Outcome ◽

Vertebral Body ◽

Karnofsky Performance Status ◽

Performance Status ◽

Spinal Tuberculosis ◽

Vertebral Body Replacement ◽

Spinal Tumors ◽

Karnofsky Performance Status Scale ◽

Significant Change

OBJECTIVE: Synthetic vertebral body replacement has been widely used recently to treat different spinal conditions affecting the anterior column. They arrange from trauma, infections, and even tumor conditions. In this study, we assess the functional outcome of this modality in different spinal conditions. PATIENTS AND METHODS: Thirty-six cases operated from October 2010 to December 2017. Twelve patients had spinal type A3 fractures, 11 cases with spinal tuberculosis (TB), and 13 cases with spinal tumors. They were followed clinically for a mean period of 2.4 years. RESULTS: All the cases were approached anteriorly. Seven cases had a post-operative infection. No neurological worsening reported. We had dramatic neurological improvement in all spinal TB cases. Mortality recorded in only 4 cases with metastatic spinal tumor during the mean period of follow-up. Karnofsky performance status scale showed statistically significant change for spinal TB, and tumor cases during the follow-up period, but there was no significant change in cases of spinal type A3 fractures. CONCLUSION: The positive outcome of this surgery makes it recommended for properly selected patients, especially with spinal TB and tumors.

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Outcome of intra-articular hyaluronic acid in treatment of osteoarthritis of knee at a tertiary care hospital in Kathmandu, Nepal

Janaki Medical College Journal of Medical Science ◽

10.3126/jmcjms.v7i1.30004 ◽

2019 ◽

Vol 7 (1) ◽

pp. 36-40

Author(s):

Deepak Kumar Dutta

Keyword(s):

Hyaluronic Acid ◽

Knee Osteoarthritis ◽

Functional Outcome ◽

Tertiary Care ◽

Oxford Knee Score ◽

Functional Improvement ◽

Care Hospital ◽

Post Intervention ◽

Viscous Solution

Background and Objectives: Intra-articular hyaluronic acid is widely used in the treatment of knee osteoarthritis. This study aimed to assess the efficacy of hyaluronic acid in moderate severity knee osteoarthritis. Material and Methods: Patients of knee osteoarthritis were administered single intra-articular injection of Hyaluronic Acid 25 mg (2.5 ml viscous solution) and were followed up at 4, 12, and 24 weeks. Functional improvement was assessed using Oxford Knee Score (OKS). Comparisons of pre- and post-intervention mean OKS scores were done by paired t test. Results: Total 50 patients (mean age 58.62±12.62 years) were studied. In the six months follow up, patients showed marked improvement in functional outcome from a mean OKS of 27 before injection to 39 at 4 weeks and remained constant up to 6months of follow up. Conclusion: Intra-articular hyaluronic acid injectionas a treatment modality for moderate grade knee osteoarthritis provides good functional outcome and pain control for up to six months.

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Extradural Spinal Tumors: Report of 36 Cases and Review of Literature

Nepal Journal of Neuroscience ◽

10.3126/njn.v13i1.15905 ◽

2016 ◽

Vol 13 (1) ◽

pp. 3-10

Author(s):

Gopal R Sharma ◽

Nilam Khadka ◽

Rajiv Jha ◽

Dhurba R Adhikari ◽

Prakash Bista

Keyword(s):

Back Pain ◽

Soft Tissues ◽

Relevant Literature ◽

Bone Cyst ◽

Neurological Status ◽

Motor Deficit ◽

Spinal Tumors ◽

Metastatic Lesions ◽

Wide Range

About 55% of spinal tumors are extradural arising from vertebral bodies, epidural and surrounding neural and soft tissues. More than 90% of extradural spinal tumors are metastatic lesions. Extradural spinal tumors are common cause of back pain, sensory motor deficit and sphincters dysfunction. The wide range of lesions and varied clinical profile, make management of spinal extradural tumors a challenging task for any neurosurgeon.Aim of this study is to analyze and discuss the results of extradural spinal tumors after surgical treatment and relevant literature will be reviewed.This is a retrospective study of 36 patients who were operated for spinal extradural tumors between May 1999 and December 2012 in our institute.Follow up period ranged from 3 years to 12 years. Functional neurological outcome was assessed by McCormick's grading. There were 20 male and 16 female and age ranged from 10 to 80 years. 30 patients presented with back pain and 15 had radicular pain. On presentation 18 patients had motor sensory deficit and 15 had sphincters dysfunction. Most common involved level of spines were thoracic followed by cervical and lumbar.Gross total excision of masses were carried out in all cases. Common pathologies were neurofibromas (16), Ewing's sarcoma (7), granulomas (3), metastatic lesions (2), angiolipoma (2), chondroma (2), aneurysmal bone cyst (1), plasmacytoma (1), rabdomyosarcoma (1) and neuroblastoma (1).Out of 14 patients who harbored malignant pathology 12 patients received radio and chemotherapy. Post operative wound infection occurred in 5 patients. Regarding post operative neurological status, 18 patients showed improvement, 6 patients remained same and 12 patients had deteriorated neurology. Tumor recurrence occurred in 15 patients; 12 patients with malignant and 3 patients with benign lesions on follow up period. There was no surgery related mortality, however, 11 patients died during 3 years follow up period due to adverse pathology they were having.Nepal Journal of Neuroscience 13:3-10, 2016

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Functional outcome of arthroscopic Bankart repair for anterior shoulder instability based on suture anchor configuration

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20200524 ◽

2020 ◽

Vol 6 (2) ◽

pp. 301

Author(s):

Madan Ballal ◽

Tarun Jayakumar

Keyword(s):

Functional Outcome ◽

Shoulder Instability ◽

Bankart Repair ◽

Functional Improvement ◽

Anterior Shoulder Instability ◽

Suture Anchors ◽

Arthroscopic Bankart Repair ◽

Significant Difference ◽

Functional Scores

Background: The objective of the study was to evaluate the functional outcome of arthroscopic Bankart repair for anterior shoulder instability to assess whether the number and position of suture anchors plays a role in determining the functional outcome.Methods: This was a prospective study on 32 patients operated with arthroscopic Bankart repair between December 2017 to April 2019. Pre-op and regular follow-up scores were measured at 1 month, 3 months and 6 months post-op using Rowe score and American Shoulder and Elbow Surgeons score to assess functional outcome.Results: Mean age of the study group was 24.5±6.9 years. Functional outcome as determined by Rowe score and ASES score at 6 months follow-up were found to be 90.5±7.2 and 85.9±14.1 respectively when compared to the pre-op scores of 23.2±8.2 and 47.9±5.7 respectively; all of which showed highly significant functional improvement with highly significant reduction in visual analog scale (VAS) pain score. Patients had no recurrent dislocations with mean external rotation limitation of 5o. 25 (78.1%) patients had two suture anchors inserted and 7 (21.9%) patients had multiple (>2) anchors; and when analysis was done, there was no statistically significant difference between number of suture anchors used with respect to the functional scores.Conclusions: We conclude that arthroscopic Bankart repair is a useful and successful procedure. Patient identification and selection remains the key in determining the success of repair. Meticulous surgical technique and correct positioning of suture anchors may help in reducing the number of anchors without compromising on the final functional outcome, thereby reducing the economic burden on patients.

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Correlations between preoperative clinical factors and treatment outcome of spinal meningiomas – A retrospective study of a series of 31 cases

Surgical Neurology International ◽

10.25259/sni_927_2020 ◽

2021 ◽

Vol 12 ◽

pp. 236

Author(s):

Atanas Davarski ◽

Borislav Kitov ◽

Georgi Apostolov ◽

Ivo Kehayov ◽

Rumyana Stoyanova

Keyword(s):

Retrospective Study ◽

Neurological Deficit ◽

Motor Deficits ◽

Clinical Factors ◽

Total Resection ◽

Simpson Grade ◽

Initial Symptoms ◽

Spinal Meningiomas ◽

Outcome Of Surgery

Background: The purpose of the current study is to identify the correlations between the most important preoperative clinical factors and the outcome of surgery of spinal meningiomas (SM). Methods: We performed a retrospective analysis of the medical history, clinical, paraclinical, neuroimaging, and surgical protocol data in 31 patients with SM who underwent surgical resection at our institution from January 2011 to July 2020. The degree of resection was assessed on the Simpson scale. The modified McCormick scale was used to monitor the effect and outcome of treatment at admission, discharge, and at further follow-up. Results: The average age of the patients was 65 years (37-78). Vertebral pain and motor deficits were the most common initial symptoms that occurred in 26 (89.6%) and 29 (93.5%) patients, respectively. Sphincter disorders were found in 9 (29%) patients. Total resection (Simpson Grade I – II) was achieved in 29 patients (93.5%). We achieved a favorable outcome (McCormick Gr. I to III) in 93.3% of patients. The degree of the neurological deficit (P = 0.026) and the presence of sphincter disorders (P = 0.009) were the preoperative clinical factors that most significantly correlated with the outcome of treatment. Conclusion: The outcome from the surgical treatment of SM correlated significantly with the degree of the preoperative neurological deficit. Therefore, patients presenting with more severe symptoms are expected to have worse outcomes.

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PATH-35. AKT1(E17K) MUTATIONS ARE FREQUENT GENOMIC EVENTS IN CERVICAL SPINAL MENINGIOMAS

Neuro-Oncology ◽

10.1093/neuonc/noab196.487 ◽

2021 ◽

Vol 23 (Supplement_6) ◽

pp. vi122-vi123

Author(s):

Majd Alkhatib ◽

Gabriele Schackert ◽

Tareq Juratli

Keyword(s):

Cervical Spine ◽

Hot Spot ◽

Molecular Study ◽

Targeted Sequencing ◽

Molecular Profile ◽

Imaging Data ◽

Who Grade ◽

Simpson Grade ◽

Spinal Meningiomas ◽

Male Patients

Abstract INTRODUCTION Spinal meningiomas represent about one-third of all spine tumors. To date, little is known about the molecular profile of spinal meningiomas and their clinical impact. In this study, we correlate clinical parameters with targeted sequencing findings in a well-characterized cohort of 42 patients with spinal meningiomas. METHODS Samples from 42 spinal meningiomas (31 females and 11 males) were collected. Targeted sequencing for AKT1 E17K hot spot mutations was performed. Furthermore, clinical and imaging data were collected and correlated with the AKT1 mutation status. RESULTS Gross total resection (Simpson grade I /II) was achieved in all patients. The mean follow-up period was 60 months (6 –288 months). None of the patients demonstrated a tumor recurrence. AKT1E17K mutations were detected in 8 patients (19%), in five male and three female patients (p= 0.019). Although the majority of resected meningiomas (n= 28, 66.6%) were located in the thoracic spine, meningiomas originating in the cervical spine harbored significantly more AKT1 E17K mutations (6 out of 14, p= 0.010). Notably, all AKT1 mutated meningiomas arose ventrally or ventrolaterally to the spinal cord. The histologic examination revealed a WHO Grade 1 in 36 meningiomas (85.7%): 21 meningothelial, 8 psammomatous, 5 transitional, 2 fibrous. The remaining six meningiomas were classified as atypical WHO grade 2. Remarkably, AKT1 E17K mutations were significantly related to a meningothelial subtype (p= 0.044). CONCLUSIONS Our molecular study demonstrates that AKT1 E17K mutations are a frequent genomic event in spinal meningiomas. The majority of AKT1 mutated meningiomas occurred in male patients, originate in the cervical spine, and exhibit meningothelial histology.

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Influence of renal impairment on clinical outcomes after endovascular recanalization in vertebrobasilar artery occlusions

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2021-018003 ◽

2021 ◽

pp. neurintsurg-2021-018003

Author(s):

Lulu Xiao ◽

Mengmeng Gu ◽

Yijiu Lu ◽

Pengfei Xu ◽

Jinjing Wang ◽

...

Keyword(s):

Renal Impairment ◽

Functional Outcome ◽

Recurrent Stroke ◽

Intravenous Thrombolysis ◽

Functional Improvement ◽

Regression Analyses ◽

Anterior Circulation ◽

Vertebrobasilar Artery ◽

Favorable Functional Outcome

BackgroundRenal impairment (RI) is associated with worse outcomes in the treatment of intravenous thrombolysis and emergent endovascular treatment (EVT) in anterior circulation stroke. The objective of this study was to investigate the association of RI with short-term and long-term outcomes in patients with vertebrobasilar artery occlusions (VBAO) who received EVT.MethodsConsecutive patients with VBAO receiving EVT involving 21 stroke centers were retrospectively included. Multivariate regression analyses were used to evaluate the association of RI with mortality and symptomatic intracranial hemorrhage (sICH) during the hospital stay, and also mortality, favorable functional outcome (modified Rankin Scale (mRS) score of 0–3), and functional improvement (shift in mRS score) at 3 months and 1 year follow-up. The association between RI and the risk of recurrent stroke was evaluated with multivariate competing-risk regression analyses.ResultsAfter adjustment for potential confounders, RI was independently associated with sICH (OR 3.30, 95% CI 1.55 to 7.18), as well as mortality (OR 2.54, 95% CI 1.47 to 4.38; OR 3.07, 95% CI 1.72 to 8.08), favorable functional outcome (OR 0.33, 95% CI 0.17 to 0.66; OR 0.25, 95% CI 0.12 to 0.51), and functional improvement (OR 0.45, 95% CI 0.28 to 0.74; OR 0.35, 95% CI 0.21 to 0.60) at 3 months and 1 year follow-up, respectively, but RI was not associated with in-hospital mortality. Additionally, there was no significant association between RI and recurrent stroke within 1 year.ConclusionsOur findings suggest that RI is associated with a higher risk of sICH in hospital and a decrease in survival, favorable functional outcome, and functional improvement at 90 days and 1 year follow-up.Trial registration numberURL: http://www.chictr.org.cn/; Unique identifier: ChiCTR2000033211.

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