scholarly journals Spinal Meningiomas: Influence of Cord Compression and Radiological Features on Preoperative Functional Status and Outcome

Cancers ◽  
2021 ◽  
Vol 13 (16) ◽  
pp. 4183
Author(s):  
Valentina Baro ◽  
Alessandro Moiraghi ◽  
Valentina Carlucci ◽  
Luca Paun ◽  
Mariagiulia Anglani ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Functional Status ◽  
Tumor Volume ◽  
Volume Ratio ◽  
Cord Compression ◽  
Spinal Meningioma ◽  
Multicenter Cohort ◽  
Dural Tail ◽  
Spinal Meningiomas

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.

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

Cancers ◽  
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.

scholarly journals Spinal meningiomas: clinicoradiological factors predicting recurrence and functional outcome

2016 ◽  
Vol 41 (2) ◽  
pp. E6 ◽  
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.

scholarly journals Health-Related Quality of Life and Return to Work after Surgery for Spinal Meningioma: A Population-Based Cohort Study

Cancers ◽  
2021 ◽  
Vol 13 (24) ◽  
pp. 6371
Author(s):  
Jenny Pettersson-Segerlind ◽  
Ann-Christin von von Vogelsang ◽  
Alexander Fletcher-Sandersjöö ◽  
Charles Tatter ◽  
Tiit Mathiesen ◽  
...  
Keyword(s):  
Quality Of Life ◽  
General Population ◽  
Return To Work ◽  
Health Related Quality ◽  
Spinal Meningioma ◽  
Related Quality ◽  
Health Related ◽  
Spinal Meningiomas

Spinal meningiomas are the most common primary spinal intradural tumor. This study aimed to assess Health-related quality of life (HRQoL) and the frequency of return to work in patients surgically treated for spinal meningiomas, in comparison to the general population. Variables were collected from patient charts, EQ-5D-3L, and study specific questionnaires. Patients who had been operated between 2005–2017 were identified in a previous study and those alive in 2020 (104 of 129) were asked to participate. Eighty-four patients (80.8%) with a mean follow-up of 8.7 years, responded and were included. Data was compared to the Stockholm Public Health Survey 2006, a cross-sectional survey of a representative sample of the general population. Analysis for potential non-response bias showed no significant differences. Women in the meningioma sample scored more problems than men with regards to mobility (p = 0.048). There were no significant differences concerning EQ-5Dindex (p = 0.325) or EQVAS (p = 0.116). The correlation between follow-up time and EQ-5Dindex was low (r = 0.167). When comparing HRQoL to the general population sample, no significant differences were found within the EQ-5D-3L dimensions, EQ-5Dindex or EQVAS. Those who postoperatively scored 3–5 on mMCs scored significantly more problems in the EQ-5D-3L dimension mobility (p = 0.023). Before surgery, 41 (48.8%) of the spinal meningioma patients were working and after surgery all returned to work, the majority within three months. Seventy-eight (96%) of the patients would accept surgery for the same diagnosis if asked today. We conclude that surgery for spinal meningiomas is associated with good long-term HRQoL and a high frequency of return to work.

scholarly journals Clinical Outcome of HIV-Infected Patients with Sustained Virologic Response to Antiretroviral Therapy: Long-Term Follow-Up of a Multicenter Cohort

PLoS ONE ◽  
2006 ◽  
Vol 1 (1) ◽  
pp. e89 ◽  
Author(s):  
Félix Gutierrez ◽  
Sergio Padilla ◽  
Mar Masiá ◽  
José A. Iribarren ◽  
Santiago Moreno ◽  
...  
Keyword(s):  
Antiretroviral Therapy ◽  
Clinical Outcome ◽  
Sustained Virologic Response ◽  
Virologic Response ◽  
Multicenter Cohort ◽  
Long Term Follow Up

scholarly journals Clinical features and prognostic factors in spinal meningioma surgery from a multicenter study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Kazuyoshi Kobayashi ◽  
Kei Ando ◽  
Tomohiro Matsumoto ◽  
Koji Sato ◽  
Fumihiko Kato ◽  
...  
Keyword(s):  
Prognostic Factors ◽  
Clinical Features ◽  
Benign Tumors ◽  
Spinal Meningioma ◽  
Surgical Morbidity ◽  
Factors Associated ◽  
Simpson Grade ◽  
Dural Tail ◽  
Grade Ii

AbstractMeningiomas are benign tumors that are treated surgically. Local recurrence is likely if the dura is preserved, and en bloc tumor and dura resection (Simpson grade I) is recommended. In some cases the dura is cauterized and preserved after tumor resection (Simpson grade II). The purpose of this study was performed to analyze clinical features and prognostic factors associated with spinal meningioma, and to identify the most effective surgical treatment. The subjects were 116 patients (22 males, 94 females) with spinal meningioma who underwent surgery at seven NSG centers between 1998 and 2018. Clinical data were collected from the NSG database. Pre- and postoperative neurological status was defined using the modified McCormick scale. The patients had a mean age of 61.2 ± 14.8 years (range 19–91 years) and mean symptom duration of 11.3 ± 14.7 months (range 1–93 months). Complete resection was achieved in 108 cases (94%), including 29 Simpson grade I and 79 Simpson grade II resections. The mean follow-up period was 84.8 ± 52.7 months. At the last follow-up, neurological function had improved in 73 patients (63%), was stable in 34 (29%), and had worsened in 9 (8%). Eight patients had recurrence, and recurrence rates did not differ significantly between Simpson grades I and II in initial surgery. Kaplan–Meier analysis of recurrence-free survival showed that Simpson grade III or IV, male, and dural tail sign were significant factors associated with recurrence (P < 0.05). In conclusion, Simpson I resection is anatomically favorable for spinal meningiomas. Younger male patients with a dural tail and a high-grade tumor require close follow-up. The tumor location and feasibility of surgery can affect the surgical morbidity in Simpson I or II resection. All patients should be carefully monitored for long-term outcomes, and we recommend lifelong surveillance after surgery.

scholarly journals Surgical results of the resection of spinal meningioma with the inner layer of dura more than 10 years after surgery

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Hiroyuki Tominaga ◽  
Ichiro Kawamura ◽  
Kosei Ijiri ◽  
Kazunori Yone ◽  
Noboru Taniguchi
Keyword(s):  
Elderly Women ◽  
Clinical Findings ◽  
Long Term Outcomes ◽  
Spinal Meningioma ◽  
Neurological Improvement ◽  
Simpson Grade ◽  
Pathological Type ◽  
Spinal Meningiomas

AbstractMost spinal meningiomas arise from the thoracic dura in middle-aged and elderly women. Simpson grade 1 resection is recommended to avoid recurrence. For ventral and ventrolateral tumors, reconstruction after total dural resection is difficult, and spinal fluid leakage is likely. To overcome this concern, Saito et al. developed the technique of resecting the tumor with the inner dural layer, preserving the outer dural layer. Although meningioma rarely recurs, the recurrence period is approximately 8 years postoperatively. No studies have evaluated long-term (> 10-year) outcomes of the Saito method. Here, we report 10 cases of the Saito method with > 10-year follow-up and compare outcomes with those of other standard approaches. Twenty-nine pathology-confirmed meningioma patients underwent surgery in our department, ten with the Saito method. We investigated resection method (dura mater treatment), pathological type, and recurrence and compared pre- and postoperative clinical findings. The median follow-up was 132 months. Recurrence occurred after Simpson grades 3 and 4 resection. Simpson grades 1, 2, and the Saito method resulted in no recurrence. Neurological symptoms improved in all patients at final follow-up. This is the first report of long-term outcomes of the Saito method. The method achieved good neurological improvement with no recurrence in > 10-year follow-up.

scholarly journals Functional outcome and morbidity after microsurgical resection of spinal meningiomas

2021 ◽  
Vol 50 (5) ◽  
pp. E20
Author(s):  
Fatma Kilinc ◽  
Matthias Setzer ◽  
Gerhard Marquardt ◽  
Fee Keil ◽  
Daniel Dubinski ◽  
...  
Keyword(s):  
Functional Outcome ◽  
Complication Rate ◽  
Tumor Recurrence ◽  
Extent Of Resection ◽  
Spinal Meningioma ◽  
Surgical Morbidity ◽  
Poor Functional Outcome ◽  
Spinal Meningiomas ◽  
Microsurgical Resection

OBJECTIVE The aim of this study was to evaluate functional outcome, surgical morbidity, and factors that affect outcomes of surgically treated patients. METHODS The authors retrospectively analyzed patients who underwent microsurgical resection for spinal meningiomas between 2009 and 2020. Patient data and potential variables were collected and evaluated consecutively. Functional outcomes were evaluated using univariate and multivariate analyses. RESULTS A total of 119 patients underwent microsurgical resection of spinal meningioma within the study period. After a mean follow-up of 25.4 ± 37.1 months, the rates of overall complication, tumor recurrence, and poor functional outcome were 9.2%, 7.6%, and 5%, respectively. Age, sex, revision surgery, and tumor recurrence were identified as independent predictors of poor functional outcome. Obesity and surgeon’s experience had an impact on the complication rate, whereas extent of resection and tumor calcification affected the rate of tumor recurrence. CONCLUSIONS Microsurgical resection of spinal meningiomas remains safe. Nevertheless, some aspects, such as obesity and experience of the surgeons that result in a higher complication rate and ultimately affect clinical outcome, should be considered when performing surgery.

scholarly journals A Rare Case of Extra Dural Dorsal Meningioma; Case Report and Analytique Review of Literature about 77 Cases

2021 ◽  
Vol 6 (05) ◽  
pp. 341-350
Author(s):  
Niamien Patrice Koffi ◽  
Mohcine Salami ◽  
Inas Elkacemi ◽  
Gazzaz Miloudi
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Compression ◽  
Cord Compression ◽  
Dorsal Spinal Cord ◽  
Female Predominance ◽  
Analytical Review ◽  
Spinal Meningiomas ◽  
Grade 3 ◽  
The Right

Spinal meningiomas are usually intra dural tumors, the purely extra dural localization is exceptional, they are easily mistaken for malignant tumor resulting in inadequate management. Only 77 cases have been reported in the literature. Less than 28 cases have been confirmed after durotomy since 1898. We report a new observation followed by an analytical review of the literature with a study of the socio-epidemiological, radiological parameters and of the neurosurgical and progressive management of extra dural spinal meningiomas. Observation: a 57-year-old, female patient with no medical history was admitted to our training for slow dorsal spinal cord compression progression since 06 months. Neurological examination found FRANKEL stage C paraplegia, higher level D7 hypoaesthesia without sphincter disorders. The medullary MRI objectified an intraspinal process of 1.5x2x1cm, well limited, of the right posterolateral of D8-D9 causing compression of the dorsal cord with an intramedullary hyper signal in T2. The D8-D9 laminectomy was performed. Surgical exploration found an extra dural lesion without intra dural extension. The excision was macroscopically complete. Histological examination was in favor of a benign meninigothelial. The post-operative course was marked by a partial and progressive recovery of the neurological deficit and no recurrence. Discussion: the retrospective analysis of literature about 49 publications was founded that, the incidence in 1933 by Elsberg was 5.5%, Haft in 1963 found 3.5%. In 2020 our study found 3.46% of all spine meningioma. The mean age is 44.19 years [8 years -85 years] with a female predominance of 2/1. The mode of revelation is in 11.53% of fortuitous discovery, in 59.93% by the high state of spinal cord compression stage C of FRANKEL. The topography is dorsal = 51.31%, cervical = 44.76%. MRI scan has been use since 1996 at 67.60%. Laminectomy was performed in 71.79% with durotomy in 11%. The excision is complete with SIMPSON I in 70% and SYMPSON III in 27%. The predominant histological is a grade 1 of meningioma = 73.41%, grade 2 = 6.32%, grade 3 = 1.26% in 19 % meningioma was not specified by the authors. Conclusion: The prognosis of extra dural spinal meningiomas according to our study is good overall with only 3 cases of recurrence of spinal meningioma in 36 patients, or 8.33% after a mean follow-up of 31.59 months [1 -168 months] with P=0,012.

Effect of Manipulation under Anesthesia of the First Knee in Staged Bilateral Total Knee Arthroplasty on Clinical Outcome and Satisfaction

2020 ◽  
Author(s):  
Jung-Won Lim ◽  
Yong-Beom Park ◽  
Dong-Hoon Lee ◽  
Han-Jun Lee
Keyword(s):  
Total Knee Arthroplasty ◽  
Patient Satisfaction ◽  
Clinical Outcome ◽  
Clinical Outcomes ◽  
Knee Arthroplasty ◽  
Knee Flexion ◽  
Functional Score ◽  
Manipulation Under Anesthesia ◽  
Total Knee

AbstractThis study aimed to evaluate whether manipulation under anesthesia (MUA) affect clinical outcome including range of motion (ROM) and patient satisfaction after total knee arthroplasty (TKA). It is hypothesized that MUA improves clinical outcomes and patient satisfaction after primary TKA. This retrospective study analyzed 97 patients who underwent staged bilateral primary TKA. MUA of knee flexion more than 120 degrees was performed a week after index surgery just before operation of the opposite site. The first knees with MUA were classified as the MUA group and the second knees without MUA as the control group. ROM, Knee Society Knee Score, Knee Society Functional Score, Western Ontario and McMaster Universities (WOMAC) score, and patient satisfaction were assessed. Postoperative flexion was significantly greater in the MUA group during 6 months follow-up (6 weeks: 111.6 vs. 99.8 degrees, p < 0.001; 3 months: 115.9 vs. 110.2 degrees, p = 0.001; 6 months: 120.2 vs. 117.0 degrees, p = 0.019). Clinical outcomes also showed similar results with knee flexion during 2 years follow-up. Patient satisfaction was significantly high in the MUA group during 12 months (3 months: 80.2 vs. 71.5, p < 0.001; 6 months: 85.8 vs. 79.8, p < 0.001; 12 months: 86.1 vs. 83.9, p < 0.001; 24 months: 86.6 vs. 85.5, p = 0.013). MUA yielded improvement of clinical outcomes including ROM, and patient satisfaction, especially in the early period after TKA. MUA in the first knee could be taken into account to obtain early recovery and to improve patient satisfaction in staged bilateral TKA.

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